Clinician’s Guide to Pathways for Interventions within the South Yorkshire and Bassetlaw Commissioning for Outcomes Policy
Lead: James Marshall, Commissioning Manager - Elective Care, SY ICB
Date published: October 2023
Date to review: November 2024
The South Yorkshire & Bassetlaw (SY&B) Commissioning for Outcomes Policy (CFO) was launched in Sheffield in October 2018 and updated in 2021 to incorporate the EBI phase 2 interventions. The aim of the policy was to ensure consistent referral guidance across the SY&B area based on a review of national evidence.
The structured referral templates/ threshold forms have been updated to be completed during consultations and we would recommend clinicians to use.
In addition to incorporating the EBI guidance, SY&B commissioners have reviewed, and where appropriate refreshed, the aspects of the policy not covered by the EBI guidance. This includes local evidence based interventions and fully incorporating the specialists plastics policies into the CFO policy.
No Longer Routinely Commssioned
Snoring surgery in the absence of OSA
Knee arthroscopy for OA
Injections for non-specific back pain
Acupuncture, except for chronic tension type headaches and migraine
Cosmetic plastic surgery procedures (see list in policy)*
Exercise ECG for screening for coronary heart disease
Dilation and curettage (D&C) for heavy menstrual bleeding (HMB) in women
Vertebral augmentation (vertebroplasty or Kyphoplasty) for painful osteoporotic vertebral fractures
Surgery to fuse the bones in the back for back pain - Fusion surgery for mechanical axial low back pain
Helmet therapy in the treatment of positional plagiocephaly in children
Pathway - If the clinician feels that a case is exceptional they should send a referral letter to the IFR team via the secure email address below:
syicb-sheffield.sybifr@nhs.net
Commissioned According to the Commissioning for Outcomes Policy Criteria
Removal of benign skin lesions*
Grommets in children
Haemorrhoidectomy
Hysterectomy for heavy menstrual bleeding
Meibomian Cyst (Chalazion)
Arthroscopic shoulder decompression (ASAD)
Carpal tunnel syndrome surgery
Dupuytren’s contracture surgery
Ganglion surgery
Trigger finger release
Varicose vein surgery
Grommets for adults
Cholecystectomy*
Surgical repair of Hernias*
Upper Eyelid Blepharoplasty
Cataract surgery
Hallux valgus correction
Hip/knee replacement
Ingrown toenail removal
Upper GI Endoscopy
Plastic surgery procedures
Vasectomy under general anaesthetic
Male circumcision
Tonsillectomy for both adults and children
Pathway (Patient meets criteria) - Complete the appropriate checklist and submit with referral via eRS Prior approval via IFR is not required.
Pathway (Patient does not meet criteria) - If there is evidence of exceptionality provide this in a referral letter , complete the checklist and send to the IFR team via the secure email address below:
syicb-sheffield.sybifr@nhs.net
Tonsillectomy for both adults and children - Send referral letter and completed checklist to the IFR team for prior approval via the secure email address below. IFR approval confirmation must be submitted with the referral via eRS:
syicb-sheffield.sybifr@nhs.net
Interventions to which the National EBI Policy Phase 1 and Phase 2 apply
Pre-operative Chest X-ray (before an operation)
Pre-operative ECG - Heart tracing (ECG) before an operation
Diagnostic coronary (invasive) angiography for low risk, stable chest pain
Specialised blood tests (troponin) for investigation of chest pain
Lipid Lowering Therapy - Regular blood tests when taking cholesterol lowering tablet
Appendicectomy without confirmation of appendicitis - Tests to confirm appendicitis
Imaging for shoulder pain
Blood transfusions
Test of the gallbladder - ERCP in acute gallstone pancreatitis without cholangitis
Surgical Intervention for Chronic Rhinosinusitis
Knee MRI for Suspected Meniscal Tears
Knee MRI when symptoms are suggestive of osteoarthritis
Appropriate Colonoscopy in the Management of Hereditary Cancer
Repeat Colonoscopy on the Lower Intestine
Knee arthroscopic Surgery for Meniscal Tears
Cystoscopy for Men with Uncomplicated Lower Urinary Tract Symptoms
Surgical Intervention for Benign Prostatic Hyperplasia
Removal of Adenoids in Glue Ear and not OSA
Lumbar Discectomy
Prostate- specific antigen (PSA) testing
Lumbar Radiofrequency facet joint denervation
MRI scan of the hip for arthritis
Surgical removal of kidney stones
Pathways - For further details see the CDO policy document.
*Subject to both CFO and EBI policy
BOTH PRIMARY AND SECONDARY CARE CLINICIANS MAY APPLY FOR EXCEPTIONAL FUNDING