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), which is part of a Prior Approvals process within Clinically Effective Commissioning (CEC). This page is aimed at explaining what LPPs/Prior Approvals are, why we have them and how applications for LPPs/Prior Approvals are assessed, with links to further information.
What is a Low Priority Procedure or Prior Approval Procedure (LPP/PAP)?
A Low Priority or Prior Approval Procedure (LPP/PAP) 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 LPP/Prior Approvals?
Many CCGs nationally, including NHS Brighton & Hove CCG, have LPP/Prior Approval 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 LPPs/Prior Approval policies helps NHS Brighton and Hove CCG to reduce ‘avoidable’ or ‘inappropriate’ referrals. It also helps the referring clinicians and patients by:
- improving the quality of clinical care, as Low Priority Procedures can offer poor clinical effectiveness, so patients may not get the best results from having them
- improving waiting times at hospitals
How does NHS Brighton & Hove CCG decide what LPPs/Prior Approvalsto 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 LPPs/Prior Approvals are funded?
NHS Brighton & Hove CCG fund the following LPPs/Prior Approvals subject to a patient meeting the threshold criteria as set out in each respective PAP.
- Arthroscopy/ Knee washout (in patients with knee osteoarthritis)
- Asymptomatic Gallstones
- Carpal tunnel syndrome (surgical treatment)
- Dilation and Curettage
- Excision of Haemorrhoids
- EXOGEN ultrasound bone healing system
- Female genital prolapse/stress incontinence (assessment)
- Foetal alcohol spectrum disorder
- Ganglia Surgery (excision of ganglia)
- Grommets in children under 12
- Grommets in older children (12 and above) and adults
- Hallux Valgus Surgery
- Hernia Treatments
- Hysterectomy for heavy menstrual bleeding
- Minimal Access Surgery for Uterine Fibroids
- Minor Skin Lesions (Treatment of)
- Primary Hip replacement surgery
- Primary Knee replacement surgery
- Reduction Mammoplasty
- Revision/Augmentation Mammoplasty
- Skin graft for scar
- Sleep apnoea in adults
- Trigger Finger
- Varicose veins
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.
Individual Funding Requests (IFR)
Some medical procedures are needed so rarely that the CCG does not have a policy in place. 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 to approve funding.
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.