Clinical Priority and Best Value
A consultation on changes to podiatry services,
adult hearing services, supply of medicines, procedures of
limited clinical value and community inpatient services.
Clinical Priority and Best Value - A public consultation
2
Clinical Priority and Best Value
A consultation on changes to podiatry services, adult
Contents
hearing services, supply of medicines, procedures of
limited clinical value and community inpatient services.
1
Foreword
...................................... 2
Who we are
...................................... 3
About this consultation document
...................................... 3
Do you need further help?
...................................... 3
The case for change
...................................... 4
Podiatry Services
...................................... 6
Adult Hearing Services
...................................... 7
Supply of Medicines
...................................... 8
Procedures of Limited Clinical Value
.................................... 11
Community Inpatient Services
.................................... 13
Consultation Questionnaire
.................................... 16
What happens next
.................................... 30
Clinical Priority and Best Value - A public consultation
Foreword
NHS Milton Keynes Clinical Commissioning Group (CCG) is the NHS
organisation that plans and commissions local health services. We are keen
to make sure that services for local people offer the best care possible, in
the most appropriate place, at the right time. It is also our responsibility to
prioritise services for those most in need and ensure that we make the best
use of every public penny we spend.
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our offer to patients. This consultation document outlines our proposals for changes to:
Podiatry services
Adult hearing services
Supply of medicines
Procedures of Limited Clinical Value
Community inpatient services
There is national clinical guidance for many of these services and we want to make sure that we
both meet the most current guidance and offer appropriate and timely services to our patients. Our
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pre-consultation discussions with clinicians and some patient /public groups. A formal public
consultation is the next step in this discussion.
The proposals have been carefully chosen to ensure that the CCG continues to prioritise those
services that deliver the greatest health gain for local people. Sometimes commissioning healthcare
HQTCYJQNGRQRWNCVKQPOGCPURTQRQUKPICFKHƂEWNVCRRTQCEJKPQTFGTVQOCMGDGUVWUGQHTGUQWTEGU
and enable best care to be available. In this consultation, we propose stopping some services being
routinely available, and putting in place stricter criteria for accessing other services. We believe that
this approach will mean that we can protect the most important services so that they can be available
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we want your views on these proposals.
The consultation runs for 8 weeks from 1st February until 29th March 2017. Your
opinion really counts and we need your feedback on our ideas. You can complete
the questions at the end of the document and send the questionnaire back to us
by Freepost, or complete it online at:
www.miltonkeynesccg.nhs.uk/clinical-priority
Thank you for taking part.
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Clinical Priority and Best Valu
Value - A public consultation
2
Who we are
We are NHS Milton Keynes Clinical Commissioning Group (CCG), overseen by NHS England. We are
led by local GP doctors. We plan and pay for major NHS healthcare services across Milton Keynes.
About this consultation document
This document tells you about podiatry, adult hearing services, supply of medicines, procedures
of limited clinical value and community inpatient services and the way in which they are managed
currently in Milton Keynes. It lays out the reasons and proposals for making changes. It also asks you
what you think of those changes.
The consultation document is split into five sections one for each service area, with a questionnaire at
the end of the document. All feedback is highly valued. However, if you do not wish to complete all
the questions you may prefer to answer questions on the sections you are particularly interested in.
Thank you for reading this document and for taking the time to think about the information. Your
answers and your opinions count. They will be used by NHS Milton Keynes CCG to help make
decisions about these services in the area.
The consultation will run from 1st February until 29th March 2017.
Do you need any further help?
We can provide versions of this document in other languages and formats such as Braille and large
print on request. Please contact the Engagement and Consultation Team on 0121 611 0259.
3
Clinical Priority and Best Value - A public consultation
The Case for Change
Milton Keynes is an area with a population that is growing significantly faster than the national
average. Milton Keynes CCG is operating within tight financial restraints and the cost of healthcare
is increasing. These factors mean that the CCG needs to take a new approach to commissioning
healthcare to ensure that the CCG can:
• Prioritise resources for those most in need.
• Continue to tackle health inequalities and improve health and health outcomes for our local
population.
• Strengthen primary care and GP capacity to deliver care at scale and provide services close to
home.
• Fulfil its statutory duty to live within its allocated resources.
• Ensure best value for NHS money.
We have undertaken a far-reaching assessment of services to come up with the proposals outlined in
this consultation document. Our proposals focus on five service areas:
•
•
•
•
•
Podiatry services
Adult hearing services
Supply of medicines
Procedures of Limited Clinical Value
Community inpatient services
How we have developed our proposals
We have spoken to clinicians, patients and members of the public to help develop these proposals.
We have also used national best practice and new clinical guidance to review our services and the
treatments and procedures we offer. We have used a number of principles throughout this review:
• To offer procedures and treatments consistently and fairly to patients.
• To ensure that services meet the latest national clinical guidance and are supported by robust
clinical evidence.
• To stop using treatments that FQPQVJCXGCP[DGPGƂVU for patients, or have a very limited
evidence base.
• To prioritise treatments which provide the ITGCVGUVDGPGƂVUto patients.
• To ensure best value for NHS money.
• To ensure services are provided in the right place at the right time and care is offered closer
to home.
We have been speaking to our patients about our proposals. They have told us that it is important that
care is provided closer to home and that patients are given choice where possible and are involved in
their care. They also feel that it is really important that patients in exceptional circumstances are given
the option to apply for procedures which may not be routinely available. Our patients are concerned
about the challenges to the NHS budget and want to ensure that the changes we make do not have
broader implications in terms of patient care and put pressure on other parts of the health and care
system.
Clinical Priority and Best Value - A public consultation
4
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As a CCG we have a 2.4% increase in funding for 2017/18, but our population is growing by 2% and
people are living longer and needing more care. Historically Milton Keynes has received less than its fair
share of NHS funding. In 2016/17 Milton Keynes’s allocation of funding was 3.9% below its assessed
fair share. The cost of healthcare is also increasing and we are experiencing a greater demand for
services.
These factors combined means that despite our increase in budget, we still have to find £9.7 million of
savings in the next financial year. Consequently, whilst our proposals are motivated by getting the best
for patients, embedding clinical excellence and improving patient care, ensuring best value for NHS
money is also absolutely vital.
What our proposals mean for patients
The pages of this consultation document outline what each of the proposed changes mean for
patients. The changes we are proposing seek to offer the people of Milton Keynes a fair and clinically
appropriate range of services delivered in the right place at the right time, and not to deprive patients
of services they need.
Where new clinical criteria are applied and an individual patient does not meet the clinical criteria set
out in the new proposals, a facility will still exist for the patient’s clinician to apply to the CCG for the
procedure through an Individual Funding Request (IFR). As part of this process they will be asked to
demonstrate why their circumstances are exceptional.
Your views are important
It is important that we get the views of our local population on these proposals in order to understand
the impact that the proposals may have and in order to tailor our approach to best meet the needs
of our population. The consultation document is split into five sections to reflect the five service areas
covered by these proposals. At the end of the document are some questions which will help us inform
our proposals and the future of services. Your contribution to this is extremely important and is valued.
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Clinical Priority and Best Value - A public consultation
Podiatry Services
Podiatry involves preventing, diagnosing, treating and rehabilitating abnormal conditions of the feet
and lower limbs.
Current service
Milton Keynes CCG currently commissions a comprehensive podiatry service for its residents, with
access for patients with minor podiatric needs, as well as for those with complex conditions meaning
that they are at higher risk of developing foot problems. Despite this, historically the number of people
requiring amputations, such as diabetics or those with vascular disease has been higher than we would
reasonably expect given our population. A review of all podiatry services has become necessary in
order to ensure care is clinically appropriate and to prioritise treatments for those most in need.
The proposal for podiatry services
The CCG wishes to ensure that in future podiatry services are available for those patients that need
them most. In order to achieve this, we propose:
• Creating access criteria to ensure that priority will be given to those at highest risk of developing
complications.
• Routine procedures such as corns, callus and nail conditions will no longer be available for those
with no underlying medical conditions.
• We estimate that the proposed changes will reduce the number of patients accepted for treatment
by 1,248. These patients will be signposted to other services where people will be able to access
care such as the Age UK Milton Keynes foot service and local private podiatry providers.
• Patients under 18 with musculoskeletal conditions will still be eligible for treatment.
• Patients who have a high/moderate podiatric need and have medical conditions such as diabetes,
rheumatoid arthritis will also still be eligible for treatment.
At the same time as amending access criteria, the CCG is proposing not to renew its current ‘Any
Qualified Provider’ podiatry contract, and instead to bring together all podiatry services into a single,
integrated service for Milton Keynes. This will make the service more efficient and consistent across the
area and will ensure that there is sufficient capacity to see and treat more complex patients in a timely
manner.
The proposed detailed podiatry access criteria are available on the CCG website:
www.miltonkeynesccg.nhs.uk/podiatry-services
Clinical
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a Best Value - A public consultation
consultation
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Adult Hearing Services
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because frequency and intensity thresholds vary depending on the reference criteria used. The World
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• Severe 61-80dB
• Profound 81dB or more
Current service
The current service offers treatment for all levels of hearing loss. A review of adult hearing services has
become necessary in order to ensure care is clinically appropriate and to prioritise treatment for those
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The proposal for adult hearing services
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• We will continue to routinely fund the provision of hearing aid equipment where hearing loss
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patient.
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by not providing hearing aids to those with mild hearing loss.
We know that some patients, who have mild/slight hearing loss, will fall outside of the proposed
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We will ensure such patients are signposted to alternative service providers.
7
Clinical Priority and Best Value - A public consultation
con
onsultation
Supply of Medicines
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TGXKGYYJKEJOGFKEKPGUCTGRTGUETKDGFVQRCVKGPVUKPQTFGTVQOCMGDGUVWUGQH0*5TGUQWTEGUCPFKP
response to some medicines being widely and cheaply available over the counter.
Gluten Free Foods
Current service
Gluten free foods are currently available upon prescription for patients with coeliac disease. Today
the availability of gluten free foods has increased dramatically and they are found in almost all major
supermarkets. Under the CCG’s current policy, people with coeliac disease can obtain a wide range
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bases, breakfast cereals and oats.
A number of CCGs across the country have already either ceased funding gluten free foods or put
restrictions on the groups to whom gluten free foods are available. The gluten free food service in
Milton Keynes costs £100,000 per annum, serving 300 patients with coeliac disease.
The proposal for gluten free foods
The CCG proposes to cease to fund the provision of gluten free foods. The only exception to this
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circumstances the patient’s GP will be able to apply to the CCG with an Individual Funding Request.
Over the counter medicines
Current service
Over the counter medicines are medicines such as painkillers, cough and cold remedies, antihistamines
and some skin products.
There is currently no policy in Milton Keynes regarding over the counter medicines and there is
considerable variation in their prescription between local practices. Many GPs have started to
encourage their patients to seek help from pharmacies and purchase their own simple medicines. The
implementation of a policy will reduce variation between practices’ prescribing approaches, providing
consistency for patients. It is expected that implementation of this policy could provide savings on
prescribing of around £66,000 per annum.
The proposal for over the counter medicines
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patients with minor ailments and self-limiting conditions to self-care or seek advice from community
pharmacists and as a result this will free up much needed GP practice time to see more serious cases
that do need their attention.
Where a treatment is needed for a long term chronic condition or there are legal restrictions on the
amount of medicine that can be purchased over the counter, then the patient’s regular clinician will
still be able to prescribe.
Clinical Priority and Best Value - A public consultation
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Repeat Prescribing
Current service
Repeat prescribing of medication to patients with long term conditions is a necessary part of the way
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ever before, patients, pharmacies and GPs have an important role to play in reducing the current level
of drug wastage. It is estimated that up to £1 million of medicines are wasted each year in Milton
Keynes.
The proposal for repeat prescribing
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• Patients or their carers will order their own repeat prescriptions directly from their practice, using a
variety of mechanisms offered by the individual practices including online ordering systems that they
can access by registering for online services with their practice.
• Pharmacies will no longer be able to order repeat prescriptions on behalf of patients. We recognise
that this penalises some pharmacies that do operate effective systems and check with patients
immediately before re-ordering and therefore only order what is needed. We want to know if an
accreditation system should be put in place to enable best practice to continue.
• GP practices will be asked to issue repeat prescriptions for a maximum of 56 days to ensure
consistency and reduce waste. Practices will also be asked to ensure that they only supply
prescriptions for the items the patient requires.
The CCG recognises the importance of ensuring that this change in policy does not prevent frail elderly
and other vulnerable patients from getting the medicines they need, and will work with local GPs and
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Clinical Priority and Best Value - A public consultation
Other Prescribing Changes
Current service
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which proposes that ‘treatments of limited clinical value are not used and medicines no longer required
are stopped’. As with over the counter medicines, there is wide variation in prescribing behaviour
amongst GP practices with regard to items on this list and reducing this variation would lead to
consistency for patients and reduce costs. The list includes vaccines for travel, branded products where
generic forms are available, high cost medicines to lower cholesterol and some patches for pain relief.
Proposal
The CCG proposes implementing restrictions on GP prescribing of items on the DROP list. This means:
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private travel clinic.
• Reduced prescribing of vitamins and other nutritional supplements.
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• Stopping use of Liothyronine for thyroid disease (an unlicensed and expensive alternative to usual
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that has the same active ingredient but a different name. In some cases the active ingredient will be
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will provide savings of around £90,000 per annum.
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Procedures of Limited Clinical Value
Procedures of Limited Clinical Value are surgical interventions or procedures where clinical evidence is
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alternative non-surgical treatment options. These procedures include amongst others: cosmetic surgery,
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Current approach
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Clinical Value. The criteria for these procedures varies between areas which means there are differences
in the availability of some procedures depending on where you live across Milton Keynes, Luton and
Bedfordshire. The CCG is working with neighbouring CCGs to improve equity of access to procedures
across the wider area and has been working with clinicians to review each of the policies to ensure
they are in line with robust clinical evidence and national guidance. This review has informed the
proposals set out below.
The proposal for Procedures of Limited Clinical Value
Our aim is that patients will continue to receive appropriate health treatment, in the right place and
at the right time. As is currently the case, treatments where clinical evidence is shown to be weak
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procedures, the CCG is proposing to introduce new clinical criteria where none previously existed and
for others the CCG is proposing to amend the current clinical criteria.
Where the individual patient does not meet the clinical criteria set out in the policy, the patient’s doctor
will be able to apply for the procedure for their patient, demonstrating why the patient’s circumstances
are exceptional, through an Individual Funding Request.
The CCG proposes that the following procedures will not be routinely funded. Therefore, funding
for patients will only be granted in clinically exceptional circumstances via an Individual Funding
Request.
Procedure
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Adenoidectomy
An adenoidectomy is an operation to remove the adenoids – small
lumps of tissue at the back of the nose, behind the palate.
Service for the removal of earwax.
Aural Microsuction (in
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Bariatric Surgery
Cosmetic Surgery
Diagnostic Colonoscopy/
Flexible Sigmoidoscopy for
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Menorrhagia
Facet Joint Injections
11
Weight loss surgery (Gastric band, Gastric Bypass & Sleeve
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Surgical procedures to enhance appearance.
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Irritable Bowel Syndrome.
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Treatment for back pain by injections.
Clinical Priority and Best Value - A public consultation
Procedure
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Female Sterilisation
A permanent method of contraception, involving a minor operation
to cut or block a woman’s fallopian tubes.
A soft tissue lump that may occur in any joint, but most often occurs
on, around, or near joints and tendons in the hands or feet.
A gap between two abdominal muscles – not considered a true
hernia.
Surgical procedure that allows doctors to view the hip joint without
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to diagnose and treat a wide range of hip problems.
Surgical procedure that allows doctors to view the knee joint without
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to diagnose and treat a wide range of knee problems.
Surgical procedure that allows doctors to view the shoulder joint
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tissues to diagnose and treat a wide range of shoulder problems.
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or periods of shallow breathing during sleep.
Treatment for back pain by injections.
Ganglions
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Knee Arthroscopy
Shoulder Arthroscopy
Sleep Apnoea
Therapeutic Injections
Toric Intraocular Lens
Implants for Astigmatism
Implanting of a lens in the eye to treat blurred or distorted vision.
The CCG is proposing to introduce or amend access criteria to the following procedures:
Procedure
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treatment of various physical and mental conditions.
Carpal Tunnel
Carpal Tunnel Syndrome is a common condition that causes a tingling
Decompression
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Dupuytren’s Contracture
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Gastroscopy for Dyspepsia
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in the upper abdomen.
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Mild Female Genital Prolapse Treatment for a small portion of the vaginal canal protruding from
the opening of the vagina.
Acupuncture
A description of each of the criteria and an explanation of the proposed changes for each procedure
can be found on the CCG website www.miltonkeynesccg.nhs.uk
Clinical Priority and Best Value - A public consultation
12
Community Inpatient Services
Community inpatient services offer inpatient care for rehabilitation or recuperation for a person after
their discharge from hospital following a period of treatment.
Once a patient has had a hospital stay it is usually the patient’s preference that they return to their
own home. Longer hospital stays can also lead to greater dependence and longer term care needs for
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people in their own homes, providing as much care and treatment at home as possible.
Current services
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own homes. The programme aims to discharge more people home, with support, rather than
them remaining in hospital. A clinical team of nurses and therapists visits the patient at home
offering support such as physiotherapy and occupational therapy, often backed by voluntary sector
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have been recently discharged from hospital.
If a patient is not well enough to return to their home, a community inpatient bed is provided as a
place of rehabilitation and recuperation while the patient’s long term care needs are assessed. There
are currently two pathways to access community inpatient services in Milton Keynes:
1. Rehabilitation
These are inpatient healthcare beds, for people who need a short period of rehabilitation before
returning to their homes. Often, these are people who are less mobile at discharge can be helped to
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There are currently 31 rehabilitation beds available in Milton Keynes: 19 beds in Windsor Intermediate
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Bletchley.
2. Recuperation
These are inpatient social care beds and are for those who require a period of convalescence or
recovery before they are ready to access reablement or rehabilitation services, or ready for their longer
term care arrangements. There are currently 10 recuperation beds available in Milton Keynes, all at
The Willows, Great Linford, Milton Keynes.
Why is change necessary?
The CCG is committed to providing as much care as possible to people in their own homes and if an
inpatient stay is required for this to be as close to home as possible. We want to expand the steps
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principles to community inpatient care.
6JGEWTTGPVOQFGNQHTGJCDKNKVCVKQPCPFTGEWRGTCVKQPDGFUKUPQVƃGZKDNGGPQWIJVQCNNQYVKOGN[CPF
appropriate access for patients to community beds. The current approach uses access criteria for
community beds for those patients who are not ready to be at home, but no longer need to be in
hospital. This means that sometimes people stay in hospital longer than they need to.
By reducing the length of hospital stays, we will not only be able to care for more people in their own
JQOGUYJGTGVJG[VGNNWUVJG[YCPVVQDGDWVCNUQVQTGNGCUGƂPCPEKCNUCXKPIUVJCVYKNNJGNRUWRRQTV
the changes we want to make to care.
13
Clinical Priority and Best Value - A public consultation
The proposal for community inpatient services
The CCG is proposing the following:
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QHNQECVKQPU
DGFUEWTTGPVN[YKVJURGEKCNKUVUGTXKEGUCPFVJGTCRKGUUWEJCURJ[UKQVJGTCR[CPF
QEEWRCVKQPCNVJGTCR[DGKPIQHHGTGFVQRGQRNGKPVJGPWTUKPIDGFUD[%GPVTCNCPF0QTVJ9GUV
.QPFQP0*5(QWPFCVKQP6TWUV
r/QTGRGQRNGYKNNDGECTGFHQTVJTQWIJVJG)GVVKPI2GQRNG*QOG2TQITCOOGCPFVJGURGEKCNKUV
UGTXKEGUCPFVJGTCR[UGTXKEGUYKNNDGKPETGCUGFKPRGQRNGoUJQOGUVQTGƃGEVVJGGZRCPUKQPQHVJKU
service.
r#UVJG)GVVKPI2GQRNG*QOG2TQITCOOGKPETGCUGUKVKUNKMGN[VJCVVJGTGYKNNDGNGUUPGGFHQT
community inpatient services so fewer nursing beds will be required.
The following examples show how the proposed service might work:
Case study 1: Discharge to community inpatient services
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had not been found for several hours, and so is very frail at admission. She had had falls previously,
but the cause for these had not been investigated. She has a broken leg, is dehydrated and is a little
confused.
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TGCF[VQIQJQOGsUJGUVKNNJCUCECUVQPJGTNGICPFTGOCKPUCNKVVNGEQPHWUGF'FKVJJGTUGNHYCPVUVQ
return to her home, but both she and her relatives know that she is not ready yet and that she may
need to make some changes to her home.
She is transferred to a community bed where she is safely cared for until her plaster cast can be
removed and she can start walking. A physiotherapist attends her each day to help her with walking
YKVJCHTCOGCPFVQTGICKPUQOGEQPƂFGPEG6JGKPVGTOGFKCVGECTGVGCOXKUKVUJGTVQFKUEWUUJGT
needs, and, after three weeks, she is ready to make a home visit with an Occupational Therapist. The
main reason for her falls becomes obvious – she has loose carpet. This is addressed by a team member,
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UJGKUQTYJQVQECNNYJGPUJGPGGFUJGNR6JGVGCOƂVUUQOGVGEJPKECNGSWKROGPVVQOCMGKVGCUKGT
for her relative to be alerted if needed.
A social worker visits her to see if she has long term care needs,
CPFKVKUCITGGFYKVJ'FKVJVJCVUJGPGGFUJGNRYKVJJGT
personal care. Once this is in place, she is discharged
home with care support attending twice a day.
Clinical Priority and Best Value - A public consultation
14
Case study 2: Discharge home with the Getting People Home Programme
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EJCKTDQWPFFWGVQKPETGCUKPIKNNJGCNVJ*KU)2CTTCPIGUHQTJKOVQDGCFOKVVGFVQJQURKVCNYKVJC
chest infection and because he is having problems walking as his knee will not straighten. After ten
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home and be able to get around as soon as he can.
#URGEKCNKUVPWTUGYKVJKPVJGJQURKVCNGZRNCKPGFVJG)GVVKPI2GQRNG*QOG2TQITCOOGVQ,QJPCPF
EJGEMUVJCVJGKUUCHGVQIQ*GKUFKUEJCTIGFNCVGTVJCVFC[KPCYJGGNEJCKTVCZKRTQXKFGFD[VJG#IG
UK Aftercare Team. The Age UK Milton Keynes volunteer helps him in, and makes him a cup of tea,
EJGEMUVJCVVJGTGKUHQQFCPFVJCVVJGJQWUGKUYCTO#OGODGTQHVJG0*5EQOOWPKV[VGCOOGGVU
him at home within the hour. They discuss what happens next, and what equipment and aids might
help him get around his home more easily.
Over the next few days, a physiotherapist and reablement assistant came to see him several times a
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CP[JGNR*KUYKHGKUCNUQUWRRQTVGFUJQYPJQYVQWUGVJGGSWKROGPVCPFJGNRGFVQWPFGTUVCPFVJG
assistance that is available to them.
15
Clinical Priority and Best Value - A public consultation
Consultation questionnaire
Thank you for reading this document and for taking the time to think about the information. This
section of the consultation document is a questionnaire. Please look through these pages and answer
the questions for the areas you are interested in or affected by. Your answers and your opinions count.
6JG[YKNNDGWUGFD[0*5/KNVQP-G[PGU%%)VQJGNROCMGFGEKUKQPUCDQWVVJGUGUGTXKEGUKPVJGCTGC
Section A is a question on the principles we have used to develop our proposals - we would like
everyone to respond to that question.
6JGPGZVƂXGUGEVKQPUQHVJGSWGUVKQPPCKTGEQXGTVJGƂXGUGTXKEGCTGCUYGCTGRTQRQUKPIEJCPIGUVQ
We value your feedback on all or any areas of this consultation, or any response you are able to give.
Section B covers Podiatry Services
Section CEQXGTU#FWNV*GCTKPI5GTXKEGU
Section D covers Supply of Medicines
Section E covers Procedures of Limited Clinical Value
Section F covers Community Inpatient Services
Section GKU'SWCNKVKGU/QPKVQTKPIYGYQWNFNKMGGXGT[QPGTGURQPFKPIVJGSWGUVKQPPCKTGVQCPUYGT
this section to ensure that our services are designed for the population we serve. The information
provided will only be used for the purpose it has been collected for and will not be passed to any third
parties.
Thank you for you time in completing this questionnaire.
You can post the questionnaire free to: Freepost NHS QUESTIONNAIRE RESPONSES. Please ensure
you use capital letters as shown in the address, so the Post Office machines can scan the address.
Alternatively, you can complete the questionnaire online at:
www.miltonkeynesccg.nhs.uk/clinical-priority
Clinical Priority and Best Value - A public consultation
16
A. Principles
Our proposals are based on a number of principles. To what extent do you
agree with these principles?
Strongly
agree
A To offer procedures and
treatments consistently and
fairly to patients
B To ensure that policies meet
the latest national clinical
guidance and are supported
by robust clinical evidence
C To stop using treatments
that do not have any
DGPGƂVUHQTRCVKGPVUQT
have very limited clinical
evidence base
D To prioritise treatments
which provide the greatest
DGPGƂVUVQRCVKGPVUHQT
those in greatest need
E To ensure best value for
0*5OQPG[YKVJKPQWT
available resources.
F To ensure services are
provided in the right place
at the right time and care is
offered closer to home.
17
Clinical Priority and Best Value - A public consultation
Agree
Neither Disagree Strongly
agree
disagree
nor
disagree
Prefer
not to
say
B. Podiatry Services
Q1. Have you had any experience of podiatry services?
;GU0Q
If yes…
As a patient
As a carer of a patient
Other (please specify: ...............................................
Q2. To what extent do you agree with the proposal for podiatry services?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q3. What support do you think people with minor podiatric needs require to help
them self-care?
Q4. Do you think this proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU
0Q
If yes please specify which group and how care will be improved:
Q5. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU
0Q
If yes please specify which group and the negative impact on care:
Q6. Please provide any additional comments on the proposal in the box below:
Clinical Priority and Best Value - A public consultation
18
C. Adult Hearing Services
Q1. Have you had any experience of adult hearing services?
;GU0Q
If yes…
As a patient
As a carer of a patient
Other (please specify: ............................................
Q2. To what extent do you agree with the proposal to issue one hearing aid rather than two
YJGTGQPGCKFKUUWHƂEKGPVVQOGGVVJGPGGFUQHVJGRCVKGPV
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q3. To what extent do you agree with the proposal to no longer supply hearing aids for
those with mild hearing loss?
5VTQPIN[CITGG Disagree
#ITGG Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q4. Do you think this proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU
0Q
If yes please specify which group and how care will be improved:
Q5. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU
0Q
If yes please specify which group and the negative impact on care:
Q6. Please provide any additional comments on the proposal in the box below:
19
Clinical Priority and Best Value - A public consultation
D. Supply of Medicines
Gluten Free Foods
Q1. Have you or your family received any prescriptions of gluten free foods?
;GU0Q
If yes…
As a patient
As a carer of a patient
Other (please specify: ...............................................
Q2. 5. To what extent do you agree with the proposal of stopping supplying gluten free
foods on prescription?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q3. Do you think this proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU
0Q
If yes please specify which group and how care will be improved:
Q4. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU
0Q
If yes please specify which group and the negative impact on care:
Q5. Please provide any additional comments on the proposal in the box below:
Clinical Priority and Best Value - A public consultation
20
Over the counter medicines
Q6. To what extent do you agree with the proposal for the prescribing of over the counter
medicines?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q7. Do you think this proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU
0Q
If yes please specify which group and how care will be improved:
Q8. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU
0Q
If yes please specify which group and how care will be improved:
Q9. The Pharmacy First scheme allows patients who do not pay a prescription charge to
obtain a few simple medicines free of charge from pharmacies. Should this scheme remain
if the proposals to stop prescribing over the counter medicines goes ahead?
;GU
0Q
Please provide any comments:
Q10. Please provide any additional comments on the proposal in the box below:
21
Clinical Priority and Best Value - A public consultation
Repeat prescribing
Q11. Do you regularly order repeat prescriptions?
;GU0Q
If yes…
As a patient
As a carer of a patient
Other (please specify: ............................................
Q12. To what extent do you agree with the proposal for only ordering repeat prescriptions
via your GP practice not via your pharmacy?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q13. Do you agree with the idea of introducing an accreditation system to allow some
pharmacies to order repeat prescriptions on behalf of patients?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q14. Do you think this proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU
0Q
If yes please specify which group and the negative impact on care:
Q15. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU
0Q
If yes please specify which group and the negative impact on care:
Q16. Please provide any additional comments on the proposal in the box below:
Clinical Priority and Best Value - A public consultation
22
E. Procedures of Limited Clinical Value
Q1. Have you had any experience of the procedures of limited clinical value?
;GU0Q
If yes…
As a patient
As a carer of a patient
Other (please specify: ............................................
Cosmetic surgery
Q2. Do you think cosmetic treatment/surgery should be routinely available and funded by
the NHS with no exceptions?
;GU0Q
Please specify why
Q3. The CCG is proposing an exception for the policy of cosmetic surgery to be made for
patients requiring reconstructive surgery after breast cancer surgery. Are there any other
exceptions that should be made for particular groups of patients?
;GU0Q
Please specify why
23
Clinical Priority and Best Value - A public consultation
$CTKCVTKE
QTYGKIJVNQUUUWTIGT[
Q4. Do you think bariatric surgery should be routinely available and funded by the NHS
with no exceptions?
;GU0Q
Please specify why
Q5. Are there any exceptions that should be made for bariatric surgery for particular groups
of patients?
;GU0Q
Please specify why
Other Procedures of Limited Clinical Value
Q6. Do you agree with the principle of ensuring consistency of service regardless of
geography by aligning the Milton Keynes policies for Procedures of Limited Clinical Value
with neighbouring CCGs in Bedfordshire and Luton?
5VTQPIN[CITGG Disagree
#ITGG
Strongly disagree
0GKVJGTCITGGPQTFKUCITGG Q7. Do you agree with the list of procedures that are proposed not to be routinely funded?
;GU0Q
If no, please specify which procedure and what change you suggest:
Clinical Priority and Best Value - A public consultation
24
Q8. Do you agree with the list of procedures that are proposed to have access criteria
introduced or amended?
;GU0Q
If no, please specify which procedure and what change you suggest:
Q9. Do you think the proposal would improve the care of any particular group of patients
within the Milton Keynes community?
;GU0Q
If yes please specify which group and how care will be improved:
Q10. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU0Q
If yes please specify which group and the negative impact on care:
Q11. Please provide any additional comments on the proposal in the box below:
25
Clinical Priority and Best Value - A public consultation
F. Community Inpatient Services
Q1. Do you agree with the principle of supporting more people in their own homes,
providing as much care and treatment at home as possible?
;GU0Q
Please specify why
Q2. Do you think the proposal for community inpatient services would improve the care of
any particular group of patients within the Milton Keynes community?
;GU0Q
If yes please specify which group and how care will be improved:
Q3. Do you think this proposal would have a negative impact on the care of any particular
group of patients within the Milton Keynes community?
;GU0Q
If yes please specify which group and the negative impact on care:
Q4. Please provide any additional comments on the proposal in the box below:
Clinical Priority and Best Value - A public consultation
26
G. Equalities Monitoring
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committed to treating everyone with dignity and respect regardless of age,
disability, gender reassignment, marriage and civil partnership, pregnancy and
maternity, race, religion or belief, sex (gender) or sexual orientation.
To ensure that our services are designed for the population we serve, we
would like you to complete the short monitoring section below.
The information provided will only be used for the purpose it has been
collected for and will not be passed to any third parties.
Q1. 9JCVKUVJGƂTUVRCTVQH[QWTRQUVEQFG!GI/-
............................................................................................................................................................
Q2. What is your gender?
Male
Female
Transgender
Prefer not to say
Q3. Has your gender (sex) changed since birth?
;GU
0Q
2TGHGTPQVVQUC[
Q4. If female, are you currently pregnant or have you given birth within the last 12 months?
;GU0Q 2TGHGTPQVVQUC[
Q5. What is your age?
7PFGT2TGHGTPQVVQUC[
Q6. What is your ethnic group?
African
Gypsy/ Traveller
Somali
Arab
Indian
White British
Bangladeshi
Irish
Prefer not to say
Caribbean
Pakistani
Chinese
Polish
Q7. What is your religion and belief?
0QTGNKIKQP
$CJCoK $WFFJKUV
Christian KPENWFKPI%JWTEJQH'PINCPF%CVJQNKE2TQVGUVCPVCPFCNNQVJGT%JTKUVKCPFGPQOKPCVKQPU
*KPFW ,CKP ,GYKUJ
Muslim
Sikh
Prefer not to say
27
Clinical Priority and Best Value - A public consultation
Q8. Do you look after, or give any help or support to family members, friends, neighbours
or others who have any of the following. Please note this is not referring to the person you
ECTGKH[QWJCXGURGEKƂGFECTGTQTKH[QWCTGEQORNGVKPIVJKUUWTXG[QPDGJCNHQHUQOGQPG
else.
0Q
.QPIVGTORJ[UKECNQTOGPVCNKNNJGCNNVJFKUCDKNKV[
I’d prefer not to say
Problems related to old age
Other, please describe:…………………………………...................................................................
Q9. Are your day-to-day activities limited because of a health condition or illness which has
lasted, or is expected to last, at least 12 months?
2NGCUGUGNGEVCNNVJCVCRRN[
8KUKQP
UWEJCUFWGVQDNKPFPGUUQTRCTVKCNUKIJV
*GCTKPI
UWEJCUFWGVQFGCHPGUUQTRCTVKCNJGCTKPI
/QDKNKV[
UWEJCUFKHƂEWNV[YCNMKPIUJQTVFKUVCPEGUENKODKPIUVCKTU
&GZVGTKV[
UWEJCUNKHVKPICPFECTT[KPIQDLGEVUWUKPICMG[DQCTF
#DKNKV[VQEQPEGPVTCVGNGCTPQTWPFGTUVCPF
NGCTPKPIFKUCDKNKV[FKHƂEWNV[
Memory
Mental ill-health
5VCOKPCQTDTGCVJKPIFKHƂEWNV[QTHCVKIWG
Social or behavioural issues (for example, due to neuro diverse conditions such as autism,
CVVGPVKQPFGƂEKVFKUQTFGTQT#URGTIGTUoU[PFTQOG
0Q
Prefer not to say
Q10. What is your sexual orientation?
$KUGZWCN*GVGTQUGZWCNUVTCKIJV)C[.GUDKCP2TGHGTPQVVQUC[
Q11. Are you?
Single
0GXGTOCTTKGFQTRCTVPGTGF
Living in a couple
Married / civil partnership
Co-habiting
0QVNKXKPIKPCEQWRNG
Married (but not living with husband / wife / civil partner
5GRCTCVGF
DWVUVKNNOCTTKGFQTKPCEKXKNRCTVPGTUJKR
Divorced / dissolved civil partnership
Widowed / surviving partner / civil partner
Prefer not to say
Clinical Priority and Best Value - A public consultation
28
What happens next?
Thank you for taking time to respond to the questions in this document. Your answers, along with all
your feedback, will be independently analysed and the results and comments will be combined into a
report. The findings will be thoroughly examined and discussed by doctors, healthcare professionals
and managers. They will produce a recommendation, which will be subject to the approval of Milton
Keynes CCG which is responsible for planning and purchasing these services.
You can post the questionnaire free to: Freepost NHS QUESTIONNAIRE RESPONSES. Please ensure
you use capital letters as shown in the address, so the Post Office machines can scan the address.
Alternatively, you can complete the questionnaire online at:
www.miltonkeynesccg.nhs.uk/clinical-priority
List of public meetings
We need to hear your views to inform any future decisions and therefore hope that you will be able to
attend one of our consultation events:
Tuesday 14 March 2017, 6pm- 8pm at Christian Centre, Strudwick Drive, Oldbrook,
Milton Keynes. MK6 2TG
Monday 20 March 2017, 1pm-3pm at Christian Centre, Strudwick Drive, Oldbrook,
Milton Keynes. MK6 2TG
Please register your interest by calling 0121 611 0231 or visiting:
www.miltonkeynesccg.nhs.uk/clinical-priority
Would you like to talk to someone
e about how this
consultation has been run?
This consultation is being carried out in accordance with the guidelines published by the Cabinet
d available at:
Office published 17 July 2012, and
www.gov.uk/government/publications/consultation-principles-guidance
ublications/consultat
A ‘due regard’ assessment
nt in line with the Equality
Equa Act 2010, has been completed, which indicates
that the options are unlikely
protected by
nlikely to have a negative
negativ impact on people
ople from the groups
g
this legislation. This means that the assessment
assessm
covered issues
sues such as age, race,
race gender, maternity,
disability, marital or civil partnership status,
status sexual orientation,
tation, religion or belief. This
Th assessment is
available upon request.
equest.
However, if you
about how this consultation has been run, please
ou would like to talk to someone
som
contact: 0121
21 611 0259.
29
Clinical
al Priority and Best Value - A public consultation
consultatio
We can provide versions of this document in other languages and formats such as Braille and large
print on request.
Please contact the Engagement and Consultation Team on 0121 611 0231
.
Somali
Waxaan ku siin karnaa bug -yarahaan oo ku qoran luqado iyo habab kale sida farta
indhoolaha Braille iyo daabacad far waa -wayn markii aad soo codsato. Fadlan la
soo xiriir qaybta Ka -qaybgalka iyo Dhex -gelidda, lambarka telefoonka waa 0121 611
0231.
Polish
Jeżeli chcieliby Państwo otrzymać kopię niniejszej ulotki w tłumaczeniu na język
obcy lub w innym formacie, np. w alfabecie Braille’a lub w powiększonym druku,
prosimy skontaktować się telefonicznie z zespołem ds. zaangażowania
(Engagement and Consultation) pod numerem telefonu 0121 611 0231.
C antonese
如有要求，我們可以將本宣傳手册用其他語言或格式顯示，如盲文或大號字體。 請致
電我們的“參與部門” (Engagement and Consultation Department) 0121 611 0231.
Gujarati
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Va^ a= W a2 4 R f ] gZ c= W a2 W ?
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?Y\aOc WhIa
0121 611 0231
Hindi
ह म आ प क ो य ह प र च ा द सू र भ ाष ाए ँ म औ र
ेल ए व ं ब ड े अ र ो ज ैस ी
क रन े पर
ा य क र स क त े है । कृ प य ा क र के इ न ग े म ट औ र इ
टॅ ल फ ॉन
व ार ा 0121 611 0231
प रे ख ा म
न व ेद न
0121 611 0231
0121 611 0231
Clinical Priority and Best Value - A public consultation
30
NHS Milton Keynes
Clinical Commissioning Group
Sherwood Place
Bletchley
Milton Keynes
MK3 6RT
1
Clinical Priority and Best Value - A public
publiic consultation