Commissioning Policies
Commissioning policies (containing information about treatments)
Commissioning policies contain information about treatments, and who can have those treatments paid for by the NHS. The majority of health care services provided by the NHS are routinely available and free at the point of delivery; this provision is not changing.
However, some drugs, operations and care may not be routinely funded by the NHS. Normally this is because they:
- Are not deemed clinically effective or effectiveness has yet to be determined.
- Are not cost-effective in comparison to all the competing demands on NHS funding.
- Have a low clinical priority and offer little health gain.
- Are largely cosmetic in nature.
As an Integrated Care Board (ICB), we have a responsibility to make rational decisions in determining the way in which we allocate resources and to act fairly between patients. In June 2022, we inherited approximately 150 commissioning policies from former Clinical Commissioning Groups (CCGs) which set out their local position for the more common clinical conditions/treatments which are not routinely funded. This has highlighted a variation across the geographic areas of Humber and North Yorkshire. A clinically and professionally led group is therefore leading the review of all clinical policies with the ultimate aim of reducing variation in approach and to help reduce health inequalities. This work is expected to be completed by 31 March 2025. Until a commissioning policy has been harmonised, the existing policy will remain in operation. Current policies and those policies under review are set out below.
ICB-wide approved commissioning policies can be found here
- Abdominoplasty (including repair of Diastasis Recti) and Apronectomy
- Adult Bariatric Surgery Tier 4 and follow-up pathway
- Arthroscopic hip surgery
- Arthroscopic shoulder decompression
- Botulinum toxin A injections into the bladder wall
- Breast Asymmetry Correction
- Breast Prosthesis Removal with or without Replacement
- Carpal Tunnel Syndrome Release
- Cleft (split) earlobe surgery
- Complementary alternative therapies
- Corrective Surgery, Lens Implants and Laser Treatment for Refractive error (short or long sightedness, astigmatism)
- Continuous Glucose Monitoring
- Dermal Fillers
- Dilation and Curettage (D&C) for diagnosis or treatment for heavy menstrual bleeding
- Elective Caesarean Section (non-clinical reasons)
- Epididymal Cyst Surgery
- Extra Corporeal Shockwave Therapy (ESWT), Ankle, Elbow, Heel, Hip, Shoulder
- Eyelid Surgery (Blepharoplasty)
- Face, Neck and Brow lifts (Rhytidectomy)
- Ganglion Excision
- Hair Removal by Intense pulsed light (IPL), laser or electrolysis for Hirsutism
- Hair Replacement Technologies
- Health Optimisation
- Hyperhidrosis treatment with Botulinum Toxin
- Ilizarov Technique Taylor Spatial Frame (TSF) (Frame surgery)
- Incision and Curettage of Chalazion
- Infusion therapy – Chronic non-cancer pain
- Liposuction
- Male Gynaecomastia Reduction Surgery
- Open, Wide Bore and Upright Magnetic Resonance Imaging (MRI)
- Photodynamic Therapy (PDT) – for Central Serous Retinopathy
- Pinnaplasty (Otoplasty)
- Referral to Specialist Chronic Fatigue Services
- Resperate© (Intercure Ltd)
- Reversal of Sterilisation
- Sacral nerve stimulation (neuromodulation) for Idiopathic chronic urinary retention in Men and Women
- Sacral Nerve Stimulation (SNS) – Faecal Retention
- Snoring Surgery (in the absence of obstructive sleep apnoea)
- Spinal Injections & Facet joint injections of Local Anaesthetic and Steroid (Sciatica)
- Tattoo Removal
- Thigh and buttock lift
- Tier 3 Weight Management Services
- Tonsillectomy for Recurrent Tonsillitis
- Trigger finger release surgery
- Varicose vein interventions
- Vasectomy
- Wireless or Implantable Functional Electrical Stimulation (FES)
Please note: The lists of commissioning policy statements above are not exhaustive of all interventions not routinely commissioned. For any medical procedure or treatment that is not routinely commissioned and where there is not a specific policy statement, a request via the Individual Funding Request (IFR) process must still be made. Click here to view the IFR policy.
ICB-wide commissioning policies which are not routinely commissioned can be found here
- Hyaluronic Acid Injections for Musculoskeletal Joint Pain (Synvisc)
- Penile Prothesis (Implants) Surgery
- Sativex – Delta-9-Tetrahydrocannabinol and Cannabidiol Oromucosal Spray
Please note: The lists of commissioning policy statements above are not exhaustive of all interventions not routinely commissioned. For any medical procedure or treatment that is not routinely commissioned and where there is not a specific policy statement, a request via the Individual Funding Request (IFR) process must still be made. Click here to view the IFR policy.
Commissioning policies aligned to CCG areas which remain in operation can be found here
East Riding of Yorkshire Plus Access to Infertility Treatment Policy
Hull Plus Lower urinary tract symptoms in men overview
North East Lincolnshire Plus Goole Neuro Rehab
North Lincolnshire Plus Goole Neuro Rehab
Please note: The lists of commissioning policy statements above are not exhaustive of all interventions not routinely commissioned. For any medical procedure or treatment that is not routinely commissioned and where there is not a specific policy statement, a request via the Individual Funding Request (IFR) process must still be made. Click here to view the IFR policy.
Policies which are currently under review
The order in which commissioning policies will be reviewed can be found below. The policy review process considers any new clinical evidence, national guidance such as NICE, Evidence Based Interventions, or any empirical evidence. The review will consider variations across the ICB’s geographical area and explore possible options for harmonisation. In some cases, this may result in a recommendation to increase or reduce access to some services.
Phase 1 – review now complete
Phase 2 – review now complete
Phases 3 – reviews expected to be completed early 2025
- Anal Fissure Surgery – adults
- Anal Fissure Surgery – children
- Botulinum toxin type A for Anal Fissure
- Botulinum toxin type A for Chronic Migraine
- Botulinum toxin type A for Spasmodic Dysphonia
- Bunion surgery (Hallux Valgus)
- Cataracts Surgery
- Cataracts Surgery – Second Eye
- Cataracts Surgery – Shared decision making
- Circumcision – Male adults/Penile Circumcision
- Circumcision – Male children
- Continued Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnoea
- Cyclone Plus Therapy
- Endoscopic thoracic sympathectomy-hyperhidrosis
- Exogen Ultrasound Bone Healing (Exogen Therapy)
- Grommets for Glue Ear in Children
- Haemorrhoid surgery
- Half dose verteporfin photodynamic therapy for the treatment of serious chorioretinopathy – unlicensed indication
- Hydrocele Correction
- Hysterectomy for heavy menstrual bleeding
- Intravitreal Therapies for Eye Disease
- Irrigation of the external Auditory Canal (for removal of wax)
- Lycra dynamic splinting for children with neurological impairment
- Minor foot surgery
- Oculoplastic eye problems (Oculoplasty)
- Paediatric – curly toes
- Resurfacing Procedure; Dermabrasion, Chemical Peels and Laser Treatment
- Rhinitis (Adult)
- Rhinoplasty/Septorhinoplasty/Septoplasty
- Surgical intervention for chronic rhinosinusitis
- Sleep Study
- Tendinopathies and musculoskeletal conditions
- Vasectomy under general anaesthetic
Check+ (For Clinical Use Only)
North of England Commissioning Support (NECS) has developed an online self-service system, Check+, which allows registered users to generate a prior approval ticket (PAT), subject to compliance with the agreed local policy criteria, to attach to the patient record before referral or treatment for Evidence Based Interventions (EBI), related conditions.
Check+ is also a replacement of the existing Individual Funding Request (IFR) system. The new platform allows primary and secondary care users to submit and track the progress of their IFR cases. It will support two-way communication with the IFR team and a referring clinician and provide email notifications to the respective users of any status update.