Q: My GP has said that there isn’t any funding for my treatment – why?
A: Recently there has been a substantial rise in referrals for non urgent or low priority procedures. In addition, there is increasing evidence that for some procedures significant numbers of patients report no clinical benefit. By stopping doing things which aren’t clinically necessary, we can safeguard and continue to do what’s clinically essential or urgent, such as cancer referrals and life-threatening trauma cases in A&E.
Medical needs are always at the heart of decisions about our priorities. Going forward it is clear that the NHS cannot continue to offer treatments where there is no or very limited clinical evidence or which are predominately cosmetic, rather than on health grounds.
East Surrey Clinical Commissioning Group has been talking to the people of East Surrey and have been told that the public want commissioners to make decisions that are;
- Clinically necessary
- Proven to be effective
- Equitable and
- Cost effective
Q: Are there any exceptions?
A: Individual Funding Requests (IFR) are considered for treatments that are not normally funded by the NHS. The IFR is made by a Dr (either GP or specialist) and heard by a panel. The panel comprises of an independent GP, representatives from Public Health and commissioning and a lay representative. The panel will particularly look for “exceptionality” i.e. why one case should attract funding where others would not. The panel approach does seem to be the fairest way of allocating resources.
Individual Funding Requests Policy and Operating Procedures
Treatments not routinely funded
Procedures with restictions or thresholds
Q: Does East Surrey Clinical Commissioning Group fund IVF and if so how many cycles?
A: If you are eligible, you are entitled to two cycles of IVF. ESCCG have adopted the Assisted Conception Policy from NHS Surrey (the Primary Care Trust and organisation responsible for funding before April 1 st 2013).
In order to be eligible for NHS funding of IVF you and your partner will have to meet all of the criteria listed within the policy.
Click here to view our Assisted Conception Policy
Q: Why can’t I have my Varicose Veins operated on?
A: Varicose veins are graded 1-6 according to their clinical presentation, and currently we only fund specialist assessment for cases graded, by a GP, as 3 or above. This decision was made after careful consideration and with the agreement of the South East Coast Policy Recommendation Committee.
For those patients referred to a specialist, and for whom surgery is recommended, there are still considerations. One of these considerations is that non- surgical interventions should have been tried and failed.
We do have a limited budget with which we have to fund medical treatments for East Surrey residents, but financial constraints are not the only reason for restricting the numbers of varicose vein referrals. By ensuring that only the most severe cases are seen by our specialists, we can ensure that these patients receive their appointments (and possibly their operations) much more quickly.
Q: What is NICE and do East Surrey Clinical Commissioning Group have to follow their guidelines?
A: The National Institute for Clinical Evidence (NICE) provides guidance to all NHS organisations around the safety, cost and clinical effectiveness of treatments. However, the duty to maintain financial balance and preserve essential services lies with Clinical Commissioning Groups.
Q: I have been waiting more than 18 weeks for my operation – can I go privately and send you the bill?
A: You have the right to start your consultant-led treatment within a maximum of 18 weeks from referral, unless you choose to wait longer, or it is clinically appropriate that you wait longer. This includes treatments where a consultant retains overall clinical responsibility for the service or team, or for your treatment (this means the consultant will not necessarily be present for each appointment or treatment, but will take overall responsibility for your care).
If it is not possible to be seen within the maximum waiting time, ESCCG will investigate a range of suitable alternative hospitals or community clinics that could be able to see or treat you more quickly.
However, you will need to contact the original hospital or clinic first before alternatives can be investigated for you. All treatments must be agreed in advance, and retrospective claims will not be considered.
The right to be seen within maximum waiting times does not apply:
- If you choose to wait longer
- If delaying the start of your treatment is in your best clinical interests, for example where stopping smoking or losing weight is likely to improve the outcome of the treatment
- If it is clinically appropriate for your condition to be actively monitored in secondary care without clinical intervention or diagnostic procedures at that stage
- If you fail to attend appointments that you had chosen from a set of reasonable options, or
- If the treatment is no longer necessary.
The following services are not covered:
Q: Please could you confirm which Gluten-free products you allow on prescription and how many units per month?
A: The previous system (before 2010) of supply of gluten free foods on prescription was established around 40 years ago when gluten-free foods were not readily available in supermarkets and shops.
A wide range of gluten free foods can now be purchased from all major supermarkets, including Asda, Budgens, Marks and Spencer, Morrisons, Sainsbury’s, Tesco, and Waitrose. Gluten free foods are however, currently more expensive than gluten based equivalent foods. The fact that gluten free foods were freely available on prescription may have stifled competition in this sector in the past and may have contributed to keeping prices artificially high.
The recommendation to restrict the type of gluten free products available on prescription was made by the South East Coast Primary Care Trust Alliance Regional Commission Board on 17th December 2010.
The two main reasons for adopting the recommendation were; 1) achieving the most cost effective use of NHS resources and 2) ensuring equity in the supply of dietary products across the South East Coast region.
Regional discussions were clinically-led and with some involvement of Coeliac UK, the national support group for people with coeliac disease. In April 2011, NHS Surrey wrote to all Surrey GPs informing them of the decision to implement South East Coast PCT Alliance recommendations about the prescribing of gluten free foods. GPS were asked to write to coeliac patients to inform them of the changes.
This means that the prescribing of gluten free products on FP10 (i.e. prescribed by a GP) is limited to eight items per month per patient. These eight items can be either long-life bread or flour.
The rationale for not including fresh bread is that it counts as a “special order” item and subsequently attracts an additional delivery fee of between £10 - £40. NHS Surrey (the previous commissioning organisation) felt there was insufficient justification for the additional spend which requires diverting money from treatments to be spent on delivery charges.
The supply of gluten free products on prescription had been under discussion for some time at both local and regional levels. We need to maximise the best and most equitable use of finite NHS resources, ensuring both coeliac and non-coeliac patients are treated fairly (given that no other food allergy products are available to adults free of charge, for instance to people with diabetes or who are lactose intolerant).