Commissioning Policy Individual Funding Request

Transcription

1 Commissioning Policy Individual Funding Request Individual Funding Request Policy Date Adopted: 21 August 2015 Version: Individual Funding Request Team Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group

2 Document Control Title of document Authors job title(s) Document status Head of IFR v Supersedes v Clinical approval April 2015 Discussion and Approval by Clinical Policy Review Group (CPRG) Discussion and Approval by CCG Board CPRG April 2015 June 2015 Date of Adoption 21 st August 2015 Publication/issue date 3 rd September 2015 Review date September 2018 Equality and Impact Assessment Internal Version Date Reviewer Comment v /03/2018 IFR Coordinator Rebranded to BNSSG CCG Version: v Page 2

3 THIS TREATMENT IS NOT ROUTINELY COMMISSIONED FOR ANY PATIENTS AND INDIVIUDAL FUNDING PANEL APPROVAL MUST BE SOUGHT PRIOR TO REFERRAL. THIS POLICY RELATES TO ALL PATIENTS Policy Statement & Date of Adoption: 21st August 2015 Surgical intervention for snoring is not routinely funded by the CCG. General Principles Funding approval will only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval will not be given. 1. Funding approval must be secured by primary care prior to referring patients seeking an opinion or treatment to manage snoring. Referring patients to secondary care without funding approval having been secured not only incurs significant costs in out-patient appointments for patients that may not qualify for surgery, but inappropriately raises the patient s expectation of treatment. Also, when patients who do not qualify for treatment are being seen in secondary care, this increases waiting times for patients who have received funding approval. Secondary care colleagues should reject referrals for advice on managing snoring without funding approval except where a referral is made under the 2WW pathway for suspected cancer. 2. On limited occasions, the CCG may approve funding for an assessment only in order to confirm or obtain evidence demonstrating whether a patient meets the criteria for funding. In such cases, patients should be made aware that the assessment does not mean that they will be provided with surgery and surgery will only be provided where it can be demonstrated that the patients meets the criteria to access treatment in this policy. 3. Where funding approval is given by the Individual Funding Panel, it will be available for a specified period of time, normally one year. 4. Funding approval will only be given where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where it is demonstrated that patients have previously been provided with the treatment with limited or diminishing benefit, funding approval is unlikely to be agreed. 5. If clinical assessment suggests Obstructive Sleep Apnoea Syndrome is suspected, the patient should be managed in accordance with NICE Technology Appraisal TA Version: v Page 3

4 Background Surgery for snoring includes uvulopalatopharyngoplasty (UPPP), laser-assisted uvuloplatoplasty (LAUP), soft palate implants and radiofrequency ablation. In addition, patients with nasal blockage have sought a Septorhinoplasty in order to correct deformity and improve airflow in order to address concerns with snoring. Snoring is primarily due to vibration of the soft palate, but it can also originate from the supraglottis, tonsils or tongue 2. It is estimated that 40% of the population snore 3. Patients complaining of the impact of snoring should be counselled without referral to secondary care and advice should be given on implementing the following lifestyle changes where appropriate: Weight reduction if above recommended BMI To stop smoking (offer to refer the patient to smoking cessation services) Reduce or stop evening alcohol intake Keeping the nose clear (including therapies such as nasal sprays or strips) Partners using ear plugs whilst asleep to minimise sleep disruption Self-training to alter their sleep position to avoid lying on back (e.g. sewing lump into back of pyjamas/nightdress as temporary training method). Obtaining a mandibular advancement device to be worn at night from their orthodontist. The patient must be advised that this device is not funded by the NHS Policy - Criteria to Access Treatment INDIVIDUAL FUNDING REQUEST APPROVAL REQUIRED Surgical treatment to reduce the impact of snoring is not routinely commissioned. Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed at the Commissioner s Individual Funding Request Panel upon receipt of a completed application form from the patient s GP, Consultant or Clinician. Applications cannot be considered from patients personally. Version: v Page 4

5 If you would like further copies of this policy or need it in another format, such as Braille or another language, please contact the Patient Advice and Liaison Service on or This policy has been developed with the aid of the following references: NICE TAG Main C, Liu Z, Welch K, Weiner G, Jones SQ, Stein K. Surgical procedures and non-surgical devices for the management of non-apnoeic snoring: a systematic review of clinical effects and associated treatment costs. Health Technol Assess 2009;13(3). Ohayon M M, Guilleminault C, Priest RG, Caulet M. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ. Mar ;314(7084): Quinn S J, Daly N, Ellis P D. Observation of the mechanism of snoring using sleep nasendoscopy. Clinical otolaryngology and allied sciences. Aug 1995;20(4): Approved by (committee): Clinical Policy Review Group Date Adopted: 21 August 2015 Version: Produced by (Title) Commissioning Manager Individual Funding EIA Completion Date: October 2014 Undertaken by (Title): IFR Co-ordinator Review Date: Earliest of NICE publication or three years from approval. Version: v Page 5