Planned Procedures with a Threshold policy update
5 July 2018
The NHS is required to improve the care and health of local populations.
Three new policies are currently being proposed to bring the local NHS in line with national clinical guidance and policies followed by other CCGs.
These proposed policies follow engagement with local clinicians, reviews of available clinical evidence, national guidance and engagement within NW London and will be added to the portfolio of “Planned Procedures with a Threshold Polices” (PPwT).*
The NW London Joint Committee will consider these three policy proposals at their next meeting in September 2018.
1. Management of Hallux Valgus (Bunions)
Hallux valgus (Bunions) refers to a lateral angulation of the great toe, overlying the second toe in very severe cases. The resulting prominence of the first metatarsal head is susceptible to developing inflammation in the overlying soft tissue and bursa, leading to the symptoms described above.
Management of hallux valgus is aimed at relieving symptoms, reducing deformity and preventing complications such as gait or balance problems and increased risk of falls.
The policy review looks at suggested thresholds for surgical procedures.
For more information, see here
2. Surgery for chronic rhinosinusitis
Chronic sinusitis is a common condition in which the cavities around nasal passages (sinuses) become inflamed and swollen for at least 12 weeks, despite treatment attempts.
Also known as chronic rhinosinusitis, this condition interferes with drainage and causes mucus buildup. Breathing through the nose might be difficult, the area around the eyes and face might feel swollen, and there may be facial pain or tenderness.
Chronic sinusitis can be brought on by an infection, by growths in the sinuses (nasal polyps) or by a deviated nasal septum. The condition most commonly affects young and middle-aged adults, but it also can affect children.
The proposal is to introduce a new policy based on The Royal College of Surgeons High Value Care Pathway for the Management of Chronic Sinusitis . For more information about this pathway, click here.
3. Hysterectomy for menorrhagia
In March 2018 NICE published an update to their Heavy Menstrual Bleeding: Assessment and Management guideline. NW London CCGs commissioned a piece of research and engaged with clinicians across NW London and with the NW London Policy Development Group with a view to assess what changes may need to be made to the Hysterectomy for Menorrhagia PPwT policy. The proposed policy follows these NICE recommendations, which makes having a hysterectomy an earlier option for the treatment of menorrhagia than in the current policy.
For more information click here.
***The Planned Procedures with a Threshold (PPwT) portfolio of policies are commissioned across the eight CCGs in North West London. To ensure the most effective use of resources, standardisation of clinical practice and equity of access,
The key underlying principles for the PPwT approach are:
• An evidence-based set of criteria are met so that the outcome of the procedure is effective and of benefit to the patient
• There is an opportunity for local clinical stakeholders and lay members to input into changes in policy supported by evidence.
• Procedures with the highest benefit in terms of outcomes are commissioned following an opportunity to review the evidence rationale through the NWL Policy Development Group.
For more information about PPwT, click here.