NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 29 April 2014

Transcription

1 Agenda Item No: 26.0 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 29 April 2014 Title of Report Purpose of the Report Draft Minutes of the Clinical Policy Committee held on the 11 February For information. Actions Requested Decision Discussion Information X Strategic Objectives Supported by the Report 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. Recommendations The NHS Trafford Clinical Commissioning Group Governing Body is asked to note the minutes of the Clinical Policy Committee held on the 9 July Discussion history prior to the Governing Body Financial Implications Risk Implications Impact Assessment Communications Issues Public Engagement Summary Prepared by Responsible Director Louise Hambleton, PA to COO Michael Gregory, Clinical Director for Strategy and Policy

2 CLINICAL POLICY COMMITTEE 11 February 2014 MEMBERS: Michael Gregory (Chair) - Clinical Director for Strategy & Policy Gina Lawrence - Chief Operating Officer Michael Taylor - Head of Governance, Planning & Risk Chris Tower - GP Liz Clarke - GP Lynne Blears - Practice Nurse Leigh Lord - Head of Medicines Management Lisa Davies - Consultant in Public Health Priscilla Nkwenti Lay Member IN ATTENDANCE: Tim Weedall - Head of Scheduled Care Matthew Preece - Map of Medicine Facilitator Louise Hambleton - Minute Taker APOLOGIES: John Cranston - GP Henrietta Bottomley - Practice Nurse 1 INTRODUCTIONS Michael Gregory welcomed the members to the Clinical Policy Committee. 2 DECLARATIONS OF INTEREST There were no declarations of members interests raised in line with section 8 of the Clinical Commissioning Group s Constitution. RESOLVED The Chair noted the information. Page 2

3 3 MINUTES OF THE PREVIOUS MEETING The minutes were agreed as an accurate record of the meeting with the following comments. Item 7 was queried on the minutes by TW. Item 6 LL informed the members that UHSM were looking to commission Collagenase, she will check with CMFT their position and bring back to a future meeting. RESOLVED The Chair noted the information. 4.0 REVIEW OF COPD GUIDELINES MG informed the members the PID s are being checked against the management plan, they expired at the end of A Task and Finish Group is to be set up to look at the guidelines and will include Leigh Lord, Lynne Blears, Wendy Williams, Michael Gregory and Catherine?, the existing plan is to be extended to cover the winter period. 4.1 Item was missed off the Agenda EUR Policies MG informed the members the GM policy was agreed the previous week by the GM EUR Steering Group which included all GM CCG s. MG advised the members of how the process works. Policies were produced in draft by GM CSU, they are put on the website for consultation by anyone (including the general public). CPC will feed into the consultation by MG or TW then the final policy will be discussed at the GM EUR Steering Group and agreed. Trafford CCG will request an addition to the approval process to include Management Team and the Governing Body. CPC will give clinical insight and MG will report back or individuals can report on the policies themselves. Concerns were raised about this being an electronic consultation process, were GP s involved. MG confirmed he and TW will report on the policies to the GM EUR Steering Group. 5.0 TCCG MAP OF MEDICINE PATHWAYS FOR LOCALISATION MP handed out a summary sheet outlining all the national pathways for localisation and approval through the Clinical Policy Committee. The summary included localised pathways in current development and future pathways that have been identified for 2014 onwards through the Everyone Counts Priority Planning. MP asked for amendments or additions to be raised and confirmed in an amended table that will be brought to future meetings in order to inform the committee. MT will submit the Everyone Counts Planning Priorities for Trafford on Friday 14 February. Page 3

4 When presenting the summary sheet MP highlighted a number areas where networking would be imperative for example, sexual health services are the responsibility of Trafford Council and will need to be engaged in order to outline all relevant service information to be included in any localised pathways. LD confirmed Sian Davies is the lead for the service. The group enquired about the MOM and MP confirmed contract for the North of England is under review which will be completed by 2015 and the actual end date is An options appraisal will be produced and taken to IM&T Steering Group and brought into the CPC. A question was raised about access to MOM for the PCCC, it was confirmed that Providers would potentially intend to use MOM and have protocols in place. Items 6.0, 7.0, 8.0, 9.0, 10.0, 11.0 and 12.0 were deferred to a future meeting as Michel LeStraad could not attend. MG advised 2 of the policies would be sent out to members for comments before the next meeting as they were required at the Governing Body. Item 13.0 was also deferred to the next meeting but will be sent out to members prior to this for comments CLINICAL POLICIES 14.1 Assisted Conception TW advised there is a financial issue with the policy but he is meeting Joe McGuigan to discuss this tomorrow and will report back to a future meeting Faecal Calprotectin Tests TW informed the members there is new NICE Guidance which suggests tests could be performed in Primary Care with no requirement for a colonoscopy referral. Trafford have been speaking to Ferring who would be happy to train staff in practices to perform the test and include a GP reviewer and e- consultant service. It was advised there is already a system for Trafford GP s and there may be no requirement for the involvement of Ferring. LC is to include this item at the next Education Event for GP s to raise awareness. TW is to check costs from Ferring against the Secondary Care charges and look at the possible pathway (LES). TW is to the paper out to members for further comments Abdominoplasty 14.4 Body Contouring These items have been discussed at GM EUR Steering Group, MG requested comments from the members. MG asked TW to collate responses from the members and feedback consensus Cataract Surgery Page 4

5 The presence of a cataract does not in itself indicate a need for surgery. The decision to refer a patient for surgery should be based on consideration of their visual acuity, visual impairment and their potential for functional benefits. Cataract surgery is justified and appropriate when the patient experiences one, or more of the following: The best corrected visual acuity score is 6/12 or worse in the affected eye. Difficulty carrying out everyday tasks such as recognising faces, watching TV, cooking, playing sport/cards etc. Reduced mobility, unable to drive or experiencing difficulty with steps or uneven ground. Ability to work, give care or live independently is affected. A patient should not be referred for cataract surgery if: The patient does not desire surgery. Glasses or other visual aids provide functional vision satisfactory to the patient. The patient s quality of life or ability to function is not compromised. The patient has concomitant ocular disease where functional improvement is unlikely. Patients who are not referred for surgery should remain under the care of their primary care practitioner (GP, community ophthalmologist, optometrist) and be reassessed at one- to two-year intervals as appropriate. Policy Exclusions Exceptions to the above criteria include: juvenile cataract, lens-induced disease (such as phacomorphic glaucoma, phacolytic glaucoma, and other lens-induced disease), and cataracts in patients with concomitant ocular disease that require clear media (such as diabetic retinopathy) for which cataract surgery is indicated. Individuals with any one of these indications, or where these are suspected, should be referred to an ophthalmologist. Clinicians can submit an Individual Funding Request (IFR) if they feel there is a good case for exceptionality. Exceptionality means a person to which the general rule is not applicable. Greater Manchester sets out the following guidance in terms of determining exceptionality; however the over-riding question which the IFR process must answer is whether each patient applying for exceptional funding has demonstrated that his/her circumstances are exceptional. A patient may be able to demonstrate exceptionality by showing that s/he is: Significantly different to the general population of patients with the condition in question. and as a result of that difference They are likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition. Page 5

6 The Trafford policy is being considered for GM distribution Non-Specific Low Back Pain Acupuncture; Alexander Technique; Applied Kinesiology; Aromatherapy; Autogenic Training; Ayurveda; Chiropractic; Environmental Medicine; Osteopathy; Healing; Herbal Medicine; Hypnosis; Homeopathy; Massage; Meditation; Naturopathy; Nutritional Therapy; Reflexology; Reiki; Shiatsu; Other alternative therapies Complementary medicine / alternative therapies are not funded on the NHS. Where commissioned this is part of an established treatment pathway e.g. terminal care Complementary medicine / alternative therapies are not funded as stand alone services. Cryoneurolysis / laser denervation These procedures are not commissioned. Joint injections for pain Provision of all joint injections (excluding hip/spine) for pain should only be undertaken in Primary Care settings (via minor surgery LES/DES). It will only be commissioned in secondary care for patients: Already on a care plan however these patients will be monitored to identify if there is significant benefit for treatment to be continued in primary care and discharged from secondary care. Where treatment required alongside an X-ray/ultrasound guidance. Joint injections should not be carried out where a patient could be a candidate for replacement within the next 3 months, as this could compromise the new joint. These timescales will be clarified outside the meeting. Spinal and facet joint injections for lower back pain These injections are not commissioned for lower back pain of under 12 months duration, as there is a lack of evidence of clinical efficacy. Lower back surgery for chronic back pain Lower back surgery for chronic back pain (of over 12 months duration) will only be funded as part of an agreed pathway. The following procedures are not commissioned in isolation: Intradiscal electrothermal therapy; Percutaneous intradiscal radiofrequency thermocoagulation; or Radiofrequency facet joint denervation. TAMARS: Technology assisted micro-mobilisation and reflex stimulation This procedure is not commissioned. Treatments at the Spinal Foundation Page 6

7 Treatments at the Spinal Foundation are not commissioned.it was agreed TW and CT would audit the data from Acute Trusts in March and feedback to a future meeting. Members requested early back pain advice should be included Pinnaplasty 15.0 AOB Local Policy Surgery for cosmetic reasons is not commissioned. Individual Funding Request Demonstrating Clinical Exceptionality This was agreed with measurement work ongoing. GM Operational Policy ToR to be produced for the funding and appeals panel to be signed off by CPC, MT to bring this to a future meeting. ToR for Meds Mgmnt Sub Group is to include membership from a nonmedical prescriber and also a patient representative ANY OTHER BUSINESS The members raised no items DATE, TIME AND VENUE OF FUTURE MEETINGS Wednesday 16 April, 2-4pm Chester Room, 2 nd Floor, Oakland House Page 7