Within NHS Brighton and Hove Clinical Commissioning Group (CCG) there are some medical procedures that are either not routinely funded, or require patients to meet certain eligibility criteria before they can have the treatment.
These procedures are referred to as ‘Low Priority Procedures’ (LPPs). This page is aimed at explaining what LPPs are, why we have them and how applications for LPPs are assessed, with links to further information.
What is a Low Priority Procedure (LPP)?
A Low Priority Procedure (LPP) is a medical procedure which is considered as not providing effective treatment and/or sufficient long term benefits.
A LPP is either
- a procedure which is clinically effective but only when a person meets certain criteria.
- a procedure which is potentially clinically effective but only when other alternatives, where available, have been tried first
- a procedure where not funding the treatment will not result in a significantly bad effect on the patient’s physical or mental health.
Why does NHS Brighton & Hove have LPPs?
Many CCGs nationally, including NHS Brighton & Hove CCG, have LPP policies to:
- give clear guidelines for clinicians (e.g. GPs and hospital consultants)
- help clinicians to access treatments for patients, to make sure that these treatments provide the greatest possible health gain
- make the best use of NHS resources for patients
What are the benefits of this approach?
Using LPP policies helps the NHS Brighton and Hove CCG to reduce ‘avoidable’ or ‘inappropriate’ referrals. It also helps the referring clinicians and the patients by:
- improving the quality of clinical care. Low Priority Procedures can offer poor clinical effectiveness, so patients do not get the best results from having them
- improving waiting times at hospitals by reducing the number of people going into hospital for Low Priority Procedures
How do NHS Brighton & Hove CCG decide what LPPs to fund?
NHS Brighton & Hove CCG funds certain LPPs through what is known as a Prior Approvals process (PAP). PAP assesses patients against ‘threshold criteria’, a set of criteria that must be met in order for a patient to be eligible for treatment.
A GP must decide if a patient meets the threshold criteria set out in the CCG's Prior Approvals Process for each LPP procedure. If a patient does not meet the necessary criteria, the treatment will not be funded.
Subject to approval, what Low Priority Procedures are funded?
NHS Brighton & Hove CCG fund the following LPPs subject to a patient meeting the threshold criteria as set out in each respective PAP.
- Removal of Benign Skin Lesions
- Breast Reduction
- Removal of Chalazia
- Duputren's Contracture release
- Female Sterilisation
- Removal of Ganglion
- Functional Electronic Stimulation
- Insertion / removal of Grommets and Ventilation Tubes: Adult
- Insertion / removal of Grommets and Ventilation Tubes: Child
- Tonsillectomy / Adenotonsillectomy
- Trigger Finger Release
- Varicose Vein Surgery
If a patient is assessed as not meeting the threshold criteria for a given procedure, their GP may request the procedure through an Individual Funding Request (IFR). GPs can make an application via an IFR process only when they believe that the patient has ‘exceptional’ or ‘rare’ clinical circumstances.
It is important that patients are aware that the outcome of an IFR is decided by a panel who will apply an objective approach to make sure approval is only given to cases that can demonstrate exceptionality.
What Low Priority Procedures are not routinely funded?
For procedures or interventions that are not routinely funded, funding may be available via the Individual Funding Request process. A GP or clinician should only consider submitting an IFR if they consider that the patient has rare or exceptional clinical circumstances as defined by the organisation’s IFR Policy.
Not routinely funded procedures are listed below:
- Breast Augmentation (Breast enlargement)
- Complementary and Alternative Therapies – Acupuncture
- Complementary and Alternative Therapies - Aromatherapy and Other Therapies
- Complementary and Alternative Therapies – Homeopathy
- Complementary and Alternative Therapies – Massage
- Cosmetic Procedures (Breast Lift)
- Dilation and Curettage
- Nipple Eversion
Not routinely funded procedures can only be funded via the Individual Funding Request process, and a GP should only request them if they consider that the patient has rare or exceptional clinical circumstances as described by the IFR guidance.
Individual Funding Requests (IFR)
Some medical procedures are needed so rarely that the CCG does not have a policy on them. Instead, the CCG decides whether to fund them on a case-by-case basis.
These procedures require Individual Funding Requests (IFRs) to be sent to the CCG's IFR Panel for assessment. The IFR Panel then decides whether the funding should be given.
Please see the table below for a Patient Information Leaflet on Individual Funding Requests.
You can see the CCG's IFR Policy, guidance for GPs, and an IFR form, on the IFR Information for Clinicians page.