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 highlighted a variation across the geographic areas of Humber and North Yorkshire. A clinically and professionally led group has led on the review of all clinical policies and the majority of this work has now been completed. All of the harmonised Clinical Commissioning Policies can be found below. 

ICB-wide approved commissioning policies can be found here

Abdominoplasty (including repair of Diastasis Recti) and Apronectomy IIA Abdominoplasty (including repair of Diastasis Recti) and Apronectomy	Commissioning Policy Integrated Impact Assessment
Adult Bariatric Surgery Tier 4 and follow-up pathway IIA Adult Bariatric Surgery Tier 4 and follow-up pathway	Commissioning Policy Integrated Impact Assessment
Arthroscopic hip surgery IIA Arthroscopic hip surgery	Commissioning Policy Integrated Impact Assessment
Arthroscopic Lavage and Debridement IIA Arthroscopic Lavage and Debridement	Commissioning Policy Integrated Impact Assessment
Arthroscopic shoulder decompression IIA Arthroscopic shoulder decompression	Commissioning Policy Integrated Impact Assessment
Benign skin lesion – Surgical removal (including Excision, Cryotherapy) IIA Benign skin lesion – Surgical removal (including Excision, Cryotherapy)	Commissioning Policy Integrated Impact Assessment
Biological and Bioequivalent-Biosimilar Medicines	Commissioning Policy Integrated Impact Assessment
Botulinum Toxin A and Chronic Migraine IIA Botulinum Toxin A and Chronic Migraine	Commissioning Policy Integrated Impact Assessment
Botulinum Toxin A injections into the bladder wall IIA Botulinum Toxin A injections into the bladder wall	Commissioning Policy Integrated Impact Assessment
Botulinum Toxin A for Spasmodic Dysphonia IIA Botulinum Toxin A for Spasmodic Dysphonia	Commissioning Policy Integrated Impact Assessment
Breast Asymmetry Correction IIA Breast Asymmetry Correction	Commissioning Policy Integrated Impact Assessment
Breast Enlargement Surgery IIA Breast Enlargement Surgery	Commissioning Policy Integrated Impact Assessment
Breast Prosthesis Removal with or without Replacement IIA Breast Prosthesis Removal with or without Replacement	Commissioning Policy Integrated Impact Assessment
Breast Reduction Surgery IIA Breast Reduction Surgery	Commissioning Policy Integrated Impact Assessment
Carpal Tunnel Syndrome Release IIA Carpal Tunnel Syndrome Release	Commissioning Policy Integrated Impact Assessment
Cataract surgery in adults IIA Cataract surgery in adults	Commissioning Policy Integrated Impact Assessment
Cholecystectomy IIA Cholecystectomy	Commissioning Policy Integrated Impact Assessment
Chronic anal fissure interventions (all ages) – Botulinum toxin injection, Fissurectomy and Lateral internal sphincterotomy IIA Chronic anal fissure interventions (all ages) – Botulinum toxin injection, Fissurectomy and Lateral internal sphincterotomy	Commissioning Policy Integrated Impact Assessment
Circumcision (all ages) IIA Circumcision (all ages)	Commissioning Policy Integrated Impact Assessment
Cleft (split) earlobe surgery  IIA Cleft (split) earlobe surgery	Commissioning Policy Integrated Impact Assessment
Complementary alternative therapies IIA Complementary alternative therapies	Commissioning Policy Integrated Impact Assessment
Continued Continuous Positive Airway Pressure (CPAP) IIA Continued Continuous Positive Airway Pressure (CPAP)	Commissioning Policy Integrated Impact Assessment
Corrective Surgery, Lens Implants and Laser Treatment for Refractive error (short or long sightedness, astigmatism)  IIA Corrective Surgery, Lens Implants and Laser Treatment for Refractive error (short or long sightedness, astigmatism)	Commissioning Policy Integrated Impact Assessment
Continuous Glucose Monitoring IIA Continuous Glucose Monitoring	Commissioning Policy Integrated Impact Assessment
Cosmetic/Plastic Surgery IIA Cosmetic/Plastic Surgery	Commissioning Policy Integrated Impact Assessment
Cystoscopy for men with lower urinary tract symptoms IIA Cystoscopy for men with lower urinary tract symptoms	Commissioning Policy Integrated Impact Assessment
Dermal Fillers IIA Dermal Fillers	Commissioning Policy Integrated Impact Assessment
Dilation and Curettage (D&C) for diagnosis or treatment for heavy menstrual bleeding IIA Dilation and Curettage (D&C) for diagnosis or treatment for heavy menstrual bleeding	Commissioning Policy Integrated Impact Assessment
Dupuytren’s Contracture Release – Adults IIA Dupuytren’s Contracture Release – Adults	Commissioning Policy Integrated Impact Assessment
Dynamic Splinting using Lycra Suits or Orthotics IIA Dynamic Splinting using Lycra Suits or Orthotics	Commissioning Policy Integrated Impact Assessment
Elective Caesarean Section (non-clinical reasons) IIA Elective Caesarean Section (non-clinical reasons)	Commissioning Policy Integrated Impact Assessment
Endoscopic sinus surgery for chronic rhinosinusitis IIA Endoscopic sinus surgery for chronic rhinosinusitis	Commissioning Policy Integrated Impact Assessment
Endoscopic thoracic sympathectomy IIA Endoscopic thoracic sympathectomy	Commissioning Policy Integrated Impact Assessment
Epididymal Cyst Surgery IIA Epididymal Cyst Surgery	Commissioning Policy Integrated Impact Assessment
Exogen Ultrasound Bone Healing (Exogen Therapy) IIA Exogen Ultrasound Bone Healing (Exogen Therapy)	Commissioning Policy Integrated Impact Assessment
Extra Corporeal Shockwave Therapy (ESWT), Ankle, Elbow, Heel, Hip, Shoulder IIA Extra Corporeal Shockwave Therapy (ESWT), Ankle, Elbow, Heel, Hip, Shoulder	Commissioning Policy Integrated Impact Assessment
Eyelid Surgery (Blepharoplasty) IIA Eyelid Surgery (Blepharoplasty)	Commissioning Policy Integrated Impact Assessment
Face, Neck and Brow lifts (Rhytidectomy) IIA Face, Neck and Brow lifts (Rhytidectomy)	Commissioning Policy Integrated Impact Assessment
Functional Electrical Stimulation (FES) IIA Functional Electrical Stimulation (FES)	Commissioning Policy Integrated Impact Assessment
Ganglion Excision IIA Ganglion Excision	Commissioning Policy Integrated Impact Assessment
Gastroelectrical Stimulation (GES) / Gastro neuromodulation IIA Gastroelectrical Stimulation (GES) / Gastro neuromodulation	Commissioning Policy Integrated Impact Assessment
Grommet insertion in children or adults IIA Grommet insertion in children or adults	Commissioning Policy Integrated Impact Assessment
Haemorrhoid Surgery IIA Haemorrhoid Surgery	Commissioning Policy Integrated Impact Assessment
Hallux valgus (bunion) surgery IIA Hallux valgus (bunion) surgery	Commissioning Policy Integrated Impact Assessment
Hair Removal by Intense pulsed light (IPL), laser or electrolysis for Hirsutism IIA Hair Removal by Intense pulsed light (IPL), laser or electrolysis for Hirsutism	Commissioning Policy Integrated Impact Assessment
Hair Replacement Technologies IIA Hair Replacement Technologies	Commissioning Policy Integrated Impact Assessment
Health Optimisation IIA Health Optimisation	Commissioning Policy Integrated Impact Assessment
Hip and Knee Replacement IIA Hip and Knee Replacement	Commissioning Policy Integrated Impact Assessment
Hydrocele correction IIA Hydrocele correction	Commissioning Policy Integrated Impact Assessment
Hyperhidrosis treatment with Botulinum Toxin IIA Hyperhidrosis treatment with Botulinum Toxin	Commissioning Policy Integrated Impact Assessment
Hysterectomy for menorrhagia IIA Hysterectomy for menorrhagia	Commissioning Policy Integrated Impact Assessment
Ilizarov Technique Taylor Spatial Frame (TSF) (Frame surgery) IIA Ilizarov Technique Taylor Spatial Frame (TSF) (Frame surgery)	Commissioning Policy Integrated Impact Assessment
Incision and Curettage of Chalazion IIA Incision and Curettage of Chalazion	Commissioning Policy Integrated Impact Assessment
Infusion therapy – Chronic non-cancer pain IIA Infusion therapy – Chronic non-cancer pain	Commissioning Policy Integrated Impact Assessment
Inguinal Hernia Repair (Adults) IIA Inguinal Hernia Repair (Adults)	Commissioning Policy Integrated Impact Assessment
Intravitreal injectable anti-VEGF agents for eye disease IIA Intravitreal Therapies for Eye Disease	Commissioning Policy Integrated Impact Assessment
Irrigation of the external auditory canal IIA Irrigation of the external auditory canal	Commissioning Policy Integrated Impact Assessment
Liposuction IIA Liposuction	Commissioning Policy Integrated Impact Assessment
Male Gynaecomastia Reduction Surgery IIA Male Gynaecomastia Reduction Surgery	Commissioning Policy Integrated Impact Assessment
Oculoplastic Eye Surgery IIA Oculoplastic Eye Surgery	Commissioning Policy Integrated Impact Assessment
Open, Wide Bore and Upright Magnetic Resonance Imaging (MRI) IIA Open, Wide Bore and Upright Magnetic Resonance Imaging (MRI)	Commissioning Policy Integrated Impact Assessment
Percutaneous Tibial Nerve Stimulation (PTNS) for Faecal Incontinence IIA Percutaneous Tibial Nerve Stimulation (PTNS) for Faecal Incontinence	Commissioning Policy Integrated Impact Assessment
Percutaneous Tibial Nerve Stimulation (PTNS) for Urinary Incontinence IIA Percutaneous Tibial Nerve Stimulation (PTNS) for Urinary Incontinence	Commissioning Policy Integrated Impact Assessment
Photodynamic Therapy (PDT) – for Central Serous Retinopathy IIA Photodynamic Therapy (PDT) – for Central Serous Retinopathy	Commissioning Policy Integrated Impact Assessment
Pinnaplasty (Otoplasty) IIA Pinnaplasty (Otoplasty)	Commissioning Policy Integrated Impact Assessment
Referral to Specialist Chronic Fatigue Services IIA Referral to Specialist Chronic Fatigue Services	Commissioning Policy Integrated Impact Assessment
Resperate© (Intercure Ltd) IIA Resperate© (Intercure Ltd)	Commissioning Policy Integrated Impact Assessment
Resurfacing Procedures: Dermabrasion, Chemical Peels and Laser Treatment IIA Resurfacing Procedures: Dermabrasion, Chemical Peels and Laser Treatment	Commissioning Policy Integrated Impact Assessment
Reversal of Sterilisation IIA Reversal of Sterilisation	Commissioning Policy Integrated Impact Assessment
Sacral nerve stimulation (neuromodulation) for Idiopathic chronic urinary retention in Men and Women IIA Sacral nerve stimulation (neuromodulation) for Idiopathic chronic urinary retention in Men and Women	Commissioning Policy Integrated Impact Assessment
Sacral Nerve Stimulation (SNS) – Faecal Retention IIA Sacral Nerve Stimulation (SNS) – Faecal Retention	Commissioning Policy Integrated Impact Assessment
Scar revision and skin resurfacing IIA Scar revision and skin resurfacing	Commissioning Policy Integrated Impact Assessment
Sleep Studies IIA Sleep Studies	Commissioning Policy Integrated Impact Assessment
Snoring Surgery (in the absence of obstructive sleep apnoea)  IIA Snoring Surgery (in the absence of obstructive sleep apnoea)	Commissioning Policy Integrated Impact Assessment
Spinal Epidural injections IIA Spinal Epidural injections	Commissioning Policy Integrated Impact Assessment
Spinal Injections & Facet joint injections of Local Anaesthetic and Steroid (Sciatica) IIA Spinal Injections & Facet joint injections of Local Anaesthetic and Steroid (Sciatica)	Commissioning Policy Integrated Impact Assessment
Surgery for nasal deformity (including Rhinoplasty, Septorhinoplasty and Septoplasty) IIA Surgery for nasal deformity (including Rhinoplasty, Septorhinoplasty and Septoplasty)	Commissioning Policy Integrated Impact Assessment
Tattoo Removal IIA Tattoo Removal	Commissioning Policy Integrated Impact Assessment
Tenotomy for curly toes in children IIA Tenotomy for curly toes in children	Commissioning Policy Integrated Impact Assessment
Thigh and buttock lift IIA Thigh and buttock lift	Commissioning Policy Integrated Impact Assessment
Tier 3 Weight Management Services IIA Tier 3 Weight Management Services	Commissioning Policy Integrated Impact Assessment
Tonsillectomy for Recurrent Tonsillitis IIA Tonsillectomy for Recurrent Tonsillitis	Commissioning Policy Integrated Impact Assessment
Trigger finger release surgery IIA Trigger finger release surgery	Commissioning Policy Integrated Impact Assessment
Vaginoplasty, Labiaplasty and Hymenorrhaphy IIA Vaginoplasty, Labiaplasty and Hymenorrhaphy	Commissioning Policy Integrated Impact Assessment
Varicose vein interventions IIA Varicose vein interventions	Commissioning Policy Integrated Impact Assessment
Vasectomy IIA Vasectomy	Commissioning Policy Integrated Impact Assessment
Wireless or Implantable Functional Electrical Stimulation (FES) IIA Wireless or Implantable Functional Electrical Stimulation (FES)	Commissioning Policy Integrated Impact Assessment

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

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

North East Lincolnshire

North Lincolnshire

North Yorkshire

Vale of York

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.

Click here to access Check+