We are responsible for commissioning healthcare services for the local population. These services include hospital care, community care and mental health services. In any healthcare system there are limits set on what is available and on what people can expect. CCGs are required to achieve financial balance; they have a complex task in balancing this with individuals’ rights to healthcare.
As a consequence treatments, services and medicines are prioritised against the competing needs of the population and priority is given to those which provide the greatest health gain to patients (clinical effectiveness), those which represent good value for money (cost effectiveness) and where the CCG has the resources available to invest in said services or treatments (affordability).
Below is a short summary about the procedures and treatments that are not routinely provided by the NHS, known as ‘Excluded and Restrict Procedures’ – this was previously known as ‘Procedure of Lower Clinical Value’ or POLCV.
Excluded and Restricted procedure
A clinical priorities group has been set up across south Staffordshire and have agreed a list of excluded and restricted procedures and treatments, where:
- there is little of no evidence the procedure is effective
- the procedure is only effective in certain circumstances
- the procedure is for cosmetic, rather than clinical reasons
A list of these procedures is included in the pdf Excluded and Restricted Procedures (ERP) Policy (772 KB) , which sets out the criteria that must be met before the procedure or treatment can be carried out. Consultants will use this to make decisions on whether to provide the treatment or not.
For more information please see the pdf Guide for Patients Leaflet. (321 KB)
Frequently Asked Questions
Q. Is this about saving money?
A. Quality of care is the driver for these policies, not money. The development of these policies is to tighten up practice in the community and in hospitals to ensure that the health service is offering treatments in line with the latest evidence.
Q. What if I don’t meet the criteria but there are exceptional circumstances?
A. The policy clearly states that if your GP considers your circumstances to be exceptional then they can submit an application for funding via the individual funding request (IFR) route. Find out more about Individual Funding Requests. Your GP can inform you more about the IFR route and will be able to complete the required documents.
Q. What if my condition gets worse?
A. If your condition gets worse you need to go back to your GP for further assessment.