Getting the best outcome for your
condition.
Applying a consistent, appropriate approach across
Barnsley for GP referrals
We want to ensure you are getting the best clinical outcome for your condition.
For some conditions, we know that moving directly to surgery does not always give you the
maximum benefit. Sometimes people might think that surgery is the only or best route to
take.
In fact there is a lot that can and importantly, should be done, before surgery is considered.
We have introduced a policy, using the National Institute of Clinical Excellence (NICE)
guidance, so that your doctor and consultant can refer to this guidance and apply it
consistently for everyone across Barnsley, getting the best clinical outcomes.
That’s not to say it’s a one size fits all approach – your GP will discuss what realistic
benefits you can get from different treatments and you'll decide together what could work
best for you. This information should form part of that conversation.
There are a range of conditions which NICE says that surgery is of limited clinical value and
that there are other things than can and should be tried before surgery should be
considered. This list of things are often called clinical thresholds.
What is a procedure of limited clinical value?
Procedures of limited clinical value are procedures which medical experts have suggested
have only limited or temporary benefit and which are not felt to be necessary to maintain
good health.
What is a clinical threshold?
Clinical thresholds are a set of criteria that must be met before some procedures are
considered. An example could be trying medication or in some cases gentle exercise.
These are the treatments and approaches your GP will be discussing with you.
Who decides what the best treatment is for your condition?
Surgery should be a last resort for a number of conditions and should not take place before
considering and trying other non-surgical, reasonable options.
Your GP will look for alternatives to surgery for certain procedures where NICE has said
there are better alternatives.
You will discuss the best options for you with your GP.
Barnsley CCG: getting the best outcome for your condition. Patient information April 2017. CT001
What will be Barnsley CCG’s approach to this?
Some treatments will only be considered if specific predetermined and evidence based
criteria have been met; these are the clinical thresholds for treatment as set out in the
CCG’s Clinical Thresholds policy.
Examples
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Research has shown that around 80% of individuals with carpal tunnel syndrome
initially respond to non-surgical treatment, especially among young people or
pregnant women
Gallstones are often seen on scans but do not cause any symptoms or only mild
symptoms which can be controlled by diet.
Research has shown that obese patients suffer significant complications following
hip/knee surgery, such as joint infections and poor healing.
Medical treatment for heavy menstrual bleeding is very successful and in many
circumstances prevents the need for hysterectomy and complications of surgery.
Clinical thresholds may apply to the following conditions:
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Benign Skin Lesions
Carpal Tunnel Surgery
Cataract Surgery
Cholecystectomy (Gall Bladder surgery)
Dupuytren’s Disease (a condition that affects the hands and fingers).
Ganglion Surgery
Grommets
Hernia Repair
Hip and Knee Replacement
Tonsillectomy
Trigger Finger
How do I find out more about the criteria?
A full list of the criteria and the policy is available on the Barnsley Clinical Commissioning
website http://www.barnsleyccg.nhs.uk/strategies-policies-and-plans.htm or from your GP.
What does this mean for Barnsley people?
All Barnsley GPs will follow this policy from April 2017. As a clinical commissioning group,
made up of Barnsley GPs and nurses, we think it is the best way to ensure that local NHS
funds are spent on the things that will bring greatest overall health benefit to local people.
In some circumstances, GPs, consultants or NHS clinicians may think that individuals have
exceptional clinical circumstances and may benefit from a treatment which is not routinely
provided. Requests for such treatments must be made through an Individual Funding
Request (IFR) by the clinician. This request will then be considered and approved, or
rejected, by an independent panel.
Barnsley CCG: getting the best outcome for your condition. Patient information April 2017. CT001
How can you raise a concern/complaint about this policy?
Information regarding how to raise concerns or make a complaint to Barnsley CCG can be
found at: http://www.barnsleyccg.nhs.uk/about-us/feedback-and-enquiries.htm
Alternatively you can:
Telephone: 01226 433716
Email [email protected]
Write to:
Quality Team
Barnsley CCG
Hillder House
49 – 51 Gawber Road
Barnsley
S75 2PY
Please be assured that your details will remain confidential and only be shared with
relevant staff in order to address your concerns.
For further advice you can also contact Healthwatch on 01226 320106 or
www.healthwatchbarnsley.co.uk
If you would like this information in a different format please
call 01226 433716 or email [email protected]
This information leaflet has been developed with the help of Barnsley Patient
Council members, made up of representative from GP practice patient groups.
Barnsley CCG: getting the best outcome for your condition. Patient information April 2017. CT001