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