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Procedures which require prior approval from the PCT

This section is provided for health professionals (GPs, dentists, pharmacists etc).

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Individual funding requests (IFR)

Prior approvals process

Prior approvals policies

The PCT prior approvals policies are listed below with a brief explanation of the policy and the relevant application form; Those policies without an application form are not normally funded at all, and approval is only given for exceptional cases, under our IFR policy :

Benign skins lesions

Benign skin lesions are those lesions that are not malignant, and include a range of cutaneous lesions, they are generally performed for aesthetic reasons and not routinely funded by the PCT.

Blepharoplasty

This procedure is generally performed for aesthetic reasons and not routinely funded by the PCT.

Breast Reduction

Breast reduction is usually requested for cosmetic reasons and not generally funded locally. However, the PCT has a list of criteria which will identify a small number of women who suffer significant pain as a result of large breasts and for whom funding is available.

Circumcision

The PCT funds circumcision for therapeutic reasons only, for example recurrent infection, suspected malignancy or a non-retractable foreskin. Circumcision for religious or cultural reasons is not funded.

Female circumcision is prohibited by law: The Prohibition of Female Circumcision Act 1995.

Complementary and alternative therapies

These procedures are not routinely funded by the PCT because of a paucity of information on clinical effectiveness. Some of the procedures are available through commissioned services in hospices and hospitals as part of palliative care packages.

Cosmetic procedures

Most of the work of NHS plastic surgeons concerns the restoration of appearance and function following trauma, cancer, degenerative conditions or conditions people were born with. However, some referrals are made for conditions that are considered by the Department of Health to be of lower priority or for treatments not usually available on the NHS.

Because the PCT must fund health care in the most cost effective way, cosmetic surgery is considered a low priority treatment.  This policy covers all treatment requested for cosmetic reasons in all specialties. NHS treatment will be provided on an exceptional case basis as determined by the PCT’s Exceptional Cases Panel.

Dilation and curettage

In line with NICE Clinical Guideline CG44 D&C is not recommended as a therapeutic treatment or as a diagnostic tool for heavy menstrual bleeding so will not receive prior approval for these conditions.

Dupuytren’s contracture

Most patients with Dupuytren's disease do not need treatment, but regular follow-up is needed to detect early joint contracture. Most treatment is surgical and depending whether the disease is early onset and rapid or late onset with a slower progression the treatment may be different.

Female sterilisation

Up to 20% of women may regret having a sterilisation operation. Women are encouraged to use an alternative and reversible long-term method of contraception before considering permanent sterilisation. The PCT does not fund reversal of sterilisation for men or women so requires women to have considered other options before funding sterilisation.

Ganglion

The PCT has a list of criteria which the patient must meet in order to be considered for ganglion removal.

Grommets (adult)

The PCT has a list of criteria which the patient must meet in order to be considered for grommets insertion.

Grommets (child)

The PCT has a list of criteria which the patient must meet in order to be considered for grommets insertion.

NHS Pick up of Trial Funding

 

Removal of chalazia

Chalazia are benign, granulomatous lesions caused by blockage of the Meibomian gland duct, which will normally resolve within 6 months with conservative management in primary care. The PCT has a list of criteria which the patient must meet in order to be considered for the removal of chalazia.

Spinal cord stimulation

Tonsillectomy

The PCT has a list of criteria which the patient must meet in order to be considered for a tonsillectomy. This is because the evidence suggests that the risk of surgery is only worth taking in cases where tonsillitis is severe, recurrent and disabling.

Trigger finger

The PCT has a list of criteria which the patient must meet in order to be considered for trigger finger release.

Varicose veins

There is no evidence that surgery helps patients prevent long-term complications, for example leg ulcers (if they have never had an ulcer), or that varicose veins increase the chances of a deep vein thrombosis (blood clot). Evidence suggests that treatment may help alleviate symptoms or cosmetic concerns.

To ensure that those patients with symptoms who will benefit most from surgery are prioritised, the PCT sets treatment and referral criteria for surgery.

Vertebroplasty

The PCT has a list of criteria which the patient must meet in order to be considered for a vertebroplasty.

NHS Evidence

Brighton and Hove City Teaching Primary Care Trust
Level 4, Lanchester House, Trafalgar Place, Brighton BN1 4FU Telephone: 01273 295490 Fax: 01273 574737 Email: enquiries@bhcpct.nhs.uk

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