treatment list

EIA completed and approved by PEC June 2009.

Category A - Treatments Not CommissionedCategory B - Treatments Commissioned on an Individual BasisCategory C - Procedures in this category should only be done if patients meet certain criteria and a 10% sample of all patients will be audited each year to check complianceCompliance with locally agreed Map of Medicine pathways is expected and will be audited

Drugs and treatments that are the subject of a NICE Technology Appraisal (TA) in which their use is approved will be funded by NHS Stockport within 3 months of the issue date of the NICE TA for patients who meet the criteria stipulated in the TA. Drugs and treatments that are the subject of a NICE Technology Appraisal (TA) in which their use is NOT approved will NOT be funded.These drugs and treatments are not included in this treatment list.

NHS Stockport's commissioning position in relation to NICE Interventional Procedure Guidance (IPG) is contained in a separate document: NHS Stockport commissioning position for NICE IPG.K:\Treatment list and connected policy statements\NHS Stockport commissioning position for NICE IPG.xls

Specialty Procedure Category Commissioning Positition

Haematology No This treatment is commissioned on an individual patient basis Jun-09

Neurology N/A Jun-09

Neurology No Approved on an individual basis according to certain criteria Jun-09

Neurology No Jun-09

Neurology N/A Jun-09

Neurology Sativex N/A Jun-09

Oncology Aprepitant No Jun-09

Prior approval

form available

Policy Statement Equality and Diversity checked

Betaine for homocystinuria

Prior approval - EUR team

NHS Stockport Local Policy

Statement No. 187

Botulinum Toxin – Cervical Dystonia

Group approval

Treatment of cervical dystonia with botulinum toxin is safe and effective. Stockport PCT commissions treatment via Hope Hospital, Salford.


Statement No. 10

Botulinum toxin for spasticity in adults


GM Evidence Review No.16

Botulinum Toxin A for spasticity in children


Approval according to certain criteria – BTA injections are not suitable for all children with cerebral palsy and patient selection is very important. Availability and commissioning of support services should be considered prior to approval of treatment with BTA.

GM Evidence Review No. 8

Naltrexone for Multiple Sclerosis

Not supported

This treatment is not commissioned as there is insufficient published evidence of its clinical effectiveness


Statement No. 46

Not supported

This treatment is not commissioned for neuropathic pain as there is limited published evidence of its clinical effectiveness. NHS Stockport does not commission Sativex® for symptomatic treatment in patients with moderate to severe spasticity due to Multiple Sclerosis


Statement No. 43


Approved for use as an anti-emetic 2nd line after 5HT3.

Pre-NICE Cancer drugs

recommendations to commissioners across NWSHA

2009/10


Prior approval

form available


Oncology Capecitabine N/A This is not commissioned as treatment in advanced pancreatic cancer. Jun-09

Oncology Dasatinib N/A Jun-09

Oncology Docetaxel No Jun-09

Oncology Gefitinib N/A Jun-09

Oncology N/A This is not commissioned for cholangio cancers Jun-09

Not supported



2009/10

Not supported

This is not commissioned for Acute Lymphoblastic Leukaemia (ALL) resistant to or intolerant of Imatinib.



2009/10


Approved for use in head and neck cancers in combination with Cisplatin and 5-FU in patients with a good performance status.



2009/10

Not supported

This is not commissioned for 2nd line or subsequent treatment of non-small cell lung cancer.



2009/10

Gemcitabine & Cisplatin

Not supported



2009/10


Prior approval

form available


Oncology Ibritumumab N/A Jun-09

Oncology Ixabepilone N/A This is not commissioned for metastatic breast cancer. Jun-09

Oncology Lapatinib N/A Jun-09

Oncology N/A This is not commissioned. Jun-09

Oncology Nilotinib N/A Jun-09

Not supported

This is not commissioned for consolidation therapy after induction in follicular lymphoma.



2009/10

Not supported



2009/10

Not supported

This is not commissioned for metastatic HER2 positive breast carcinoma after Herceptin.



2009/10

LMWH for DVT prevention in cancer

patients.

Not supported



2009/10

Not supported

This is not commissioned for Acute Lymphoblastic Leukaemia (ALL) resistant to or intolerant of Imatinib.



2009/10


Prior approval

form available


Oncology Posaconazole No Jun-09

Oncology Sorafenib No Jun-09

Oncology Tropotecan (oral) N/A This is not commissioned for small call lung carcinoma. Jun-09


Approved for aspergillosis following acute leukaemia and BMT when other antifungal agents have failed and where treatment is given under specialist advice from a clinician familiar with the treatment of aspergillosis.



2009/10


This is not commissioned for metastatic hepatocellular carcinoma with the exception of recurrence in a transplanted liver with otherwise normal function.



2009/10

Not supported



2009/10


Prior approval

form available


Ophthalmology NoAnti VEGF for wet AMD


The treatment of wet age-related macular degeneration (AMD) with anti-VEGF is covered by NICE TA155: Ranibizumab and Pegaptanib for the treatment of age-related macular degeneration. In this guidance Pegaptanib (Macugen) is not recommended for use in wet AMD. Ranibizumab (Lucentis) is recommended for individuals with wet AMD when the following criteria are met: The best possible visual acuity after correction with glasses or contact lenses is between 6/12 and 6/96; and There is no permanent damage to the fovea (the part of the eye that helps people to see things in sharp detail); and The area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina; and There are signs that the condition has been getting worse. A third anti VEGF, Bevacizumab (Avastin) was not considered by NICE as this drug is not licensed for use in wet AMD. NHS Stockport offers patients who meet the criteria listed above a choice of treatment with either Lucentis or Avastin. Treatment with Avastin is delivered through an NHS contract with the Alexandra Hospital, Cheadle. Treatment with Lucentis is delivered by an NHS provider, currently this is Manchester Eye Hospital. When a patient has been receiving treatment with Avastin at the Alexandra Hospital and develops a complication necessitating a change to Lucentis the patient may continue to receive care at the Alexandra Hospital. When a patient has been receiving treatment with Avastin at the Alexandra Hospital and wishes to change to Lucentis, either because the Avastin is not controlling the wet AMD sufficiently or through personal preference, the care of the patient will be transferred to an NHS provider. When a patient has been receiving an anti-VEGF privately, providing they meet the NICE criteria for treatment with an anti-VEGF, they may switch to NHS care. If the patient has been treated with Avastin and they are happy to continue they will be treated with Avastin at the Alexandra Hospital. If a patient has been treated privately with Lucentis or wishes to switch from Avastin to Lucentis on swapping from private to NHS care their care will be provided by an NHS provider.


Statement No. 51


Prior approval

form available


Ophthalmology N/A This treatment is not commissioned Jun-09

Ophthalmology No This is commissioned on an individual patient basis Jun-09

Respiratory No Jun-09

Respiratory No Jun-09

Urology N/A Jun-09

Oncology N/A Sep-09

Psychiatry N/A Sep-09

Respiratory N/A Sep-09

Infliximab for uveitis secondary to

idiopathic juvenile arthritis

Not supported


Statement No. 37

Rituximab for MAR (melanoma associated

retinopathy)



Statement No. 41

Azoles for invasive aspergillosis


Posaconazole & Voriconazole are approved for the treatment and prevention of aspergillosis when used in line with the treatment protocols available from the University Hospital of South Manchester NHS Foundation Trust.


Statement No. 34

Drugs for Primary Pulmonary (arterial)

Hypertension


Only patients who do not respond to sildenafil should be considered for treatment with an endothelian receptor antagonist (bosentan) or a prostacyclin (epoprostenol treprostinil). As all these drugs have been shown to have some degree of effectiveness but have not been directly compared, the choice of drug should therefore be based on whichever is least expensive.

Greater Manchester

Evidence Review No.6

Saw Palmetto (Prostasan)

Not supported

This herbal medicine is not commissioned as it is not licensed and there is evidence that it is not effective.


Statement No. 188

Mistletoe therapy (Iscador)

Not supported

This is not commissioned as there is limited published evidence of effectiveness


Statement No. 56

Pregabalin for Generalised Anxiety

Disorder (GAD)

Not supported



Statement No. 189

Azoles for Allergic Bronchopulmonary Apsergillosis and

fungal sensitisation in asthma

Not supported

Posaconazole and voriconazole are not commissioned for the treatment of Allergic Bronchopulmonary Aspergillosis or for fungal sensitisation in asthma as there is limited published evidence of their effectiveness in these conditions. An evidence review is attached


Statement No. 58


Prior approval

form available


Rheumatology Rituximab for SLE N/A Sep-09

Hepatology N/A This is commissioned in line with the GMMMG recommendation Sep-09

General Practice N/A Feb-10

Haematology N/A Sep-09

N/A Feb-10

Family Planning Ulipristal (EllaOne ® ) N/A Nov-09

Not supported



Statement No. 190

GM HCV strategy treatment guidelines

for hep C

Group approval


Statement No. 59

Fluconazole for thrush in breastfeeding

Not supported

This is not commissioned as there is little published evidence to support the use of fluconazole in the management of ductal candidiasis in breastfeeding women.


Statement No. 191

Siklos for Sickle Cell Crisis

Not supported

In 2009 Nordic licensed Siklos (a form of hydroxycarbamide) for Sickle Cell Crisis. Hydroxycarbamide has been available on the NHS as a licensed drug for a number of years, but neither of the two existing products are specifically licensed for Sickle Cell Crisis. Siklos will be on average 10 times the cost of the current hydroxycarbamide products. As a result only generic versions of hydroxycarbamide will be funded.


Statement No. 61

Alternative / Complementary

therapies


therapies

Not supported

Therapies included in this section are considered LOW PRIORITY. Included in this section is: 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 as stand alone services. Acupuncture is available within some musculoskeletal care pathways.


Statement No. 8

Group approval

Ellaone® is recommended as a treatment option for those patients that present between 72 and 120 hours of unprotected sexual intercourse or contraceptive failure. Levonelle® (levonorgestrel) remains the first choice for those patients that present for emergency contraception 0 to 72 hours of unprotected sexual intercourse or contraceptive failure


Statement No. 192


Prior approval

form available


General Practice N/A Nov-09

N/A Nov-09

Oncology N/A Mar-10

Oncology N/A May-10

Neurology Yes May-10

Rupatadine (Rupafin®)

Group approval

Rupatadine may be considered as a third line treatment option for allergic rhinitis after the use of more established cost effective therapies (e.g. cetirizine, loratadine) and as a second or third line treatment option in

resistant CIU.


Statement No. 193

Pain management

Oxycodone/Naloxone MR (Targinact®)

Not supported

Targinact®▼ is not recommended for routine prescribing as it has not demonstrated sufficient clinical or cost effectiveness. The clinical benefit of this preparation in patients already receiving regular laxative therapy is uncertain


Statement No. 194

Radiolabelled basiliximab for

refractory lymphoma

Not supported

Radiolabelled basiliximab for the treatment of refractory lymphoma is not commissioned by NHS Stockport owing to the lack of published evidence of effectiveness.


Statement No. 70

Cetuximab for wild type K-ras metastatic

colorectal cancer

Not supported

Cetuximab for wild type K-ras metastatic colorectal cancer is not commissioned by NHS Stockport. Cetuximab, as part of first-line treatment of certain patients with metastatic colorectal cancer is routinely funded, in accordance with NICE 176. However, the drug is not routinely funded for the second-line or subsequent treatment of metastatic colorectal cancer after the failure of an irinotecan containing chemotherapy regimen, in line with NICE TA 118. This latter appraisal did not consider K-ras status as a means of identifying patients who are unlikely to respond to treatment. A review by The School of Health and Related Research (ScHARR) University of Sheffield for Yorkshire and the Humber Specialised Commissioning Group concluded that the use of cetuximab as 3rd-line treatment of metastatic colorectal cancer in patient with wild type K-ras tumours was not considered to be cost-effective.


Statement No. 73

Botulinum toxin injections for

sialorrhoea (excessive salivation) secondary to upper motor neuron

lesions in adults

Prior approval - EUR team NHS Stockport commissions botulinum toxin injections for sialorrhoea

(excessive salivation) secondary to upper motor neuron lesions in adults on a named patient basis where other methods have failed to control the condition and where there is a high risk of aspiration.


Statement No. 77


Prior approval

form available


Respiratory N/A May-10

Oncology Alemtuzumab N/A Sep-10

Oncology Alemtuzumab Yes Sep-10

Oncology Arsenic N/A This is not commissioned for acute promyelocytic leukaemia Sep-10

Oncology Bendamustine N/A Sep-10

Oncology Bevacizumab N/A This is not commissioned as a first line treatment for breast cancer Sep-10

Oncology Bevacizumab N/A This is not commissioned for glioblastoma Sep-10

Oncology Bevacizumab N/A Sep-10

Oral posaconazole, long term Ambisome, IV Gamma Interferon,

IV Micafugin for chronic pulmonary

aspergillosis

Not supported

NHS Stockport does not commission the following for the treatment of Chronic Pulmonary Aspergillosis: Oral Posaconazole, Long term Ambisome as an outpatient, IV Gamma Interferon, IV Micafungin.


Statement No. 78

Not supported

This is not commissioned for patients with relapsed / refractory cutaneous T-cell lymphoma

GM Cancer Drugs Recommendation

2010/2011


This is commissioned for patients with chronic lymphocytic leukaemia (CLL) with the 17-q abnormality


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for first line non-Hodgkins lymphoma (NHL) including mantle cell lymphomas (MCL) in combination with rituximab


2010/2011

Not supported


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned as a first line treatment for advanced/metastatic ovarian cancer


2010/2011


Prior approval

form available


Oncology Bortezomib N/A Sep-10

Oncology Bortezomib N/A This is not commissioned for relapsed Waldenstroms macroglobulinaemia Sep-10

Oncology Capecitabine N/A Sep-10

Oncology Cetuximab N/A Sep-10

Oncology Cisplatin N/A This is not commissioned for ovarian peritoneal carcinomatosis Sep-10

Oncology Clofarabine N/A Sep-10

Oncology Dasitinib N/A Sep-10

Oncology Decitabine N/A This is not commissioned for myelodysplastic syndrome Sep-10

Not supported

This is not commissioned second or third line for mantel cell lymphoma (MCL)


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for Duke's C colorectal cancer in combination with oxaplatin based chemotherapy


2010/2011

Not supported

This is not commissioned for advanced non small cell lung cancer (NSCLC)


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for first line treatment of Acute Myeloid Leukaemia (AML) in patients >=65 years of age who have one or more of: adverse cytogenetics, secondary AML, age >= 70 years, significant comorbidities, are not considered suitable for intensive chemotherapy.


2010/2011

Not supported

This is not commissioned Chronic Myeloid Leukaemia (CML) blast crisis either first line nor following imatinib failure / intolerance


2010/2011

Not supported


2010/2011


Prior approval

form available


Oncology Degarelix No Sep-10

Oncology Docetaxel No Sep-10

Oncology N/A This is not commissioned for breast cancer Sep-10

Oncology N/A Sep-10

Oncology Erlotinib N/A Sep-10

Oncology Everolimus N/A Sep-10

Oncology Everolimus N/A This is not commissioned for pancreatic neuroendocrine tumours Sep-10

Oncology Yes Sep-10

Oncology N/A Sep-10


This is commissioned for advanced hormone dependant prostate cancer only when LHRH analogues or concommitant anti-andrgoens are contraindicated


2010/2011


This is commissioned for patients with metastatic prostate cancer who demonstrated a response to first line therapy


2010/2011

Docetaxel, carboplatin,

trastuzumab (TCH) regimen

Not supported


2010/2011

Doxorubicin with micro-beads

Not supported

This is not commissioned for chemo embolisation in hepatocellular carcinoma (HCC)


2010/2011

Not supported

This is not commissioned as maintenance therapy in non small cell lung cancer (NSCLC)


2010/2011

Not supported

This is not commissioned for the treatment of advanced and / or metastatic renal cell carcinoma (RCC) in patients whose disease has progressed on VEGF targeted therapy such as sunitinib


2010/2011

Not supported


2010/2011

Gemtuzumab Ozogomycin


The excess treatment costs of the National NRCN trial of induction for Acute Myeloid Leukaemia (AML) will be funded


2010/2011


Not supported

This is not commissioned for single agent use in relapsed Acute Myeloid Leukaemia (AML)


2010/2011


Prior approval

form available


Oncology N/A Sep-10

Oncology N/A Sep-10

Oncology N/A Sep-10

Oncology Ipilimumab N/A This is not commissioned for stage III and stage IV melanoma Sep-10

Oncology Irbitumomab N/A This is not commissioned for relapsed follicular lymphoma Sep-10

Oncology Larotaxel N/A Sep-10

Oncology Lenalidomide Yes Sep-10

Oncology Lenalidomide N/A Sep-10

Oncology Lenalidomide N/A This is not commissioned for myelodysplastic syndrome (MDS) 5q Sep-10


Not supported

This is not commissioned for patients aged >60 years of age for reinduction of Acute Myeloid Leukaemia (AML) in relapsed disease


2010/2011


Not supported

This is not commissioned for induction or reinduction of Acute Myeloid Leukaemia (AML) for those patients ineligible for the trial


2010/2011

Histamine dihydrochloride

Not supported

This is not commissioned as for first remission maintenance therapy in combination with IL-2 for Acute Myeloid Leukaemia (AML)


2010/2011

Not supported


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for second line advanced/metastatic pancreatic cancer


2010/2011


This is commissioned for 2nd line use in multiple myeloma in patients unable to tolerate bortezomib or futher thalidomide/vincristine due to neuropathy.


2010/2011

Not supported

This is not commissioned for Chronic Lymphocytic Leukaemia (CLL) refractory to chemotherapy and immunotherapy for those who have failed fludarabine and/or alemtuzumab or for whom these are unsuitable/not tolerated


2010/2011

Not supported


2010/2011


Prior approval

form available


Oncology Myocet No Sep-10

Oncology Nilotinib N/A Sep-10

Oncology No Sep-10

Oncology Pazopanib N/A Sep-10

Oncology Peg-interferon N/A This is not commissioned for stage III malignant melanoma Sep-10

Oncology Picoplatin N/A Sep-10

Oncology Pixantrone N/A Sep-10

Oncology Rituximab N/A This is not commissioned for Waldenstroms Macroglobulinaemia Sep-10

Oncology Sorafenib N/A Sep-10


This is commissioned for metastatic breast cancer in patients who have previously had the FEC-T regime and relapsed and would benefit from further anthracycline therapy but cardiac toxicity precludes its use.


2010/2011

Not supported

This is not commissioned as third line treatment of Gastrointestinal Stromal Tumour (GIST) that is advanced, unresectable and/or metastatic and resistant to both imatinib and sunitinib


2010/2011

Paclitaxel, albumin bound


This is commissioned instead of 100mg/m2 docetaxel as per the Christie Hospital protocol for metastatic breast cancer


2010/2011

Not supported

This is not commissioned for the second line treatment of metastatic renal cancer


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for second line treatment of platinum refractory or resistant small cell lung cancer


2010/2011

Not supported

This is not commissioned for third line treatment of relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) which has failed at least two other combination chemotherapy regimens


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for first line treatment of non small cell lung cancer (NSCLC)


2010/2011


Prior approval

form available


Oncology Sunitinib N/A This is not commissioned for pancreatic cancer Sep-10

Oncology Sunitinib N/A Sep-10

Oncology Sunitinib N/A Sep-10

Oncology Temozolomide N/A This is not commissioned for unresectable metastatic melanoma Sep-10

Oncology Temozolomide N/A Sep-10

Oncology Temozolomide N/A This is not commissioned for low grade gliomas Sep-10

Oncology Tolvaptan N/A Sep-10

Oncology Vandetanib N/A Sep-10

Oncology Vinflunine N/A Sep-10

Not supported


2010/2011

Not supported

This is not commissioned for metastatic breast carcinoma for patients who have received prior treatment with an anthracycline and a taxane


2010/2011

Not supported

This is not commissioned as first line treatment in combination with docetaxel for patients with unresectable locally recurrent or metastatic breast cancer


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for extended (longer than 6 months) treatment for high grade gliomas


2010/2011

Not supported


2010/2011

Not supported

This is not commissioned for hyponatraemia secondary to SIADH (syndrome of inappropriate antidiuretic hormone hypersecretion)


2010/2011

Not supported

This is not commissioned as second line treatment for non small cell lung cancer (NSCLC)


2010/2011

Not supported

This is not commissioned as second line treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a prior platinum containing regimen


2010/2011


Prior approval

form available


Oncology Zevalin N/A Sep-10

Oncology N/A Sep-10



Haematology Yes Sep-10

Not supported

This is not commissioned for consolidation after induction therapy for follicular lymphoma


2010/2012

Zoledronic acid (Zometa)

Not supported

This is not commissioned for first line adjuvant treatment (in combination with oestrogen blockade and standard endocrine therapy) of pre-menopausal stage I or II hormone-responsive breast cancer.


2010/2011

Sildenafil for pulmonary

hypertension out of proportion to COPD

Not supported

Sildenafil for pulmonary hypertension out of proportion to COPD is not commissioned by NHS Stockport.


Statement No. 80

Mycophenolate for interstitial lung disease

Not supported Mycophenolate for interstitial lung disease is not commissioned by NHS

Stockport.


Statement No. 81

Rituximab for chronic ITP in adults


Rituximab for chronic idiopathic thrombocytopenic purpura is commissioned by NHS Stockport for adult patients with a platelet count <10,000 per µL of blood who have failed to respond to standard treatment.


Statement No. 83


Prior approval

form available


Urology Erectile dysfunction N/A Sep-10

Allergy Grazax N/A Nov-10

Neurology N/A Sep-10

Group approval

No more than four treatments (not tablets) per four weeks are prescribable. Tadalafil Once Daily ® may not be prescribed. Drug treatments for erectile dysfunction should only be prescribed by General Practitioners for patients who:have a chronic disease associated with erectile dysfunction e.g. diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, spina bifida and spinal cord injury; and / orare receiving dialysis for renal failure; and / orhave had radical pelvic surgery, prostatectomy or kidney transplant; orwere previously receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® for erectile dysfunction at the expense of the NHS on the 14th September 1998.Erectile dysfunction may be a side-effect of some drug treatments for chronic conditions where possible the drug should be changed to one which has less effect on erectile function. Drug treatments for erectile dysfunction may be prescribed where a drug switich is not possible and where counteracting the erectile dysfunction side-effect will improve compliance e.g. of a regime of antipsychotics.This also applies to vacuum pumps and constrictor rings for the treatment of erectile dysfunction. Penile prosthesis will be funded: as part of reconstructive treatment following surgery of the treatment of malignant or other diseases as part of reconstructive surgery following trauma and all non-surgical methods of treatment must previously have been exhausted. Penile Prosthesis will not be funded for cosmetic reasons. Patients with erectile dysfunction may make use of any NHS psychological and psychosexual counselling services that are available within the portfolio of service agreements.


Statement No 33

Not supported

This treatment is not commissioned in line with the recommendation from the Greater Manchester Medicines Management Group New Therapies Subgroup (GMMMG NTS). The group does not recommend Grazax® for the treatment of grass pollen induced hayfever in adult patients with clinically relevant symptoms and a positive skin prick test or specific IgE test to grass pollen.


Statement No.38

Duodopa for advanced Parkinson's disease

Not supported

This is not commissioned, in line with GMMMG guidance: Co-Careldopa (Duodopa) intestinal gel for the treatment for advanced Parkinson’s disease. April 2010.


Statement No.57


Prior approval

form available


Neurology High cost MS Drugs Yes Sep-10

Neurology N/A Sep-10

Oncology Abstral N/A Nov-10

Oncology Effentora N/A Nov-10

Neurology N/A Nov-10

General Practice Erfa / Armour thyroid N/A Nov-10

Neurology Rasagiline N/A

Neurology Vitamin B12 for MS N/A Nov-10


Based on NHS Bolton's Commissioning Policy Number 6: Beta interferon, glatiramer acetate, natalizumab, mitoxantrone and azathioprine for the management of multiple sclerosis.NHS Stockport commissions beta interferon, glatiramer acetate, natalizumab, mitoxantrone and azathioprine for the managament of multiple sclerosis when certain criteria are met


Statement No. 88

Sodium oxybate for narcolepsy with

cataplexy

Not supported

This treatment is not commissioned, in line with GMMMG guidance: Sodium Oxybate (Xyrem ®) for the treatment of cataplexy in adult patients with narcolepsy. April 2010


Statement No. 42

Group approval

Abstral may be prescribed on an individual patient basis for incident or short burst pain by the Specialist Palliative Team only.


Statement No. 89

Group approval

Effentora may be presccribed on an individual patient basis for incident or short burst pain by the Specialist Palliative Team only.


Statement No. 89

Vitamin B12 for CFS/ME

Not supported

NHS Stockport doesn’t commission Vitamin B12 for the treatment of chronic fatigue syndrome due to insufficient evidence of effectiveness.


Statement No. 97

Not supported

NHS Stockport does not Erfa / Armour thyroid owing to insufficient evidence of effectiveness over standard treatment with synthetic thyroxine.


Statement No. 101

Not supported

NHS Stockport does not commission rasagiline for early or advanced Parkinson's Diseaseas as the long-term safety and its relative efficacy compared with other drugs for Parkinson’s disease have not been examined and its role in treatment can not be currently defined.


Statement No. 195

Not supported

NHS Stockport doesn’t commission Vitamin B12 for the treatment of multiple sclerosis due to insufficient evidence of effectiveness.


Statement No. 102


Prior approval

form available


Rheumatology N/A

Ophthalmology N/A

Rheumatology Lodotra N/A

Oncology Abraxane N/A This is not commissioned for the treatment of metastatic breast cancer

Oncology Afatinib N/A

Oncology Bendamustine N/A This is not commissioned for indolent non-Hodgkin's lymphoma (NHL)

Oncology Clofarabine N/A

Teriparatide for the secondary prevention of fragility fractures in

osteopenia where there is inadequate

response to or intolerance of

bisphosphonates

Not supported

NHS Stockport does not commission teriparatide for the secondary prevention of fragility fractures in osteopenia where there is inadequate

response to or intolerance of bisphosphonates owing to insufficient evidence of effectiveness


Statement No. 105

anti VEGF for retinal vein occlusion

Not supported

NHS Stockport does not commission anti VEGF for retinal vein occlusion as their use in this condition is considered experimental.


Statement No. 116

Not supported

In line with the GMMMG NTS guidance issued in February 2011 NHS Stockport does not commission the use of Prednisolone Modified Release Tablet (Lodotra ®) for the treatment of moderate to severe, active rheumatoid arthritis because of insufficient evidence of cost effectiveness over available alternatives


Statement No. 118

Not supported


2011/2012

Not supported

This is not commissioned for the treatment of non small cell lung cancer (NSCLC)


2011/2012

Not supported


2010/2011

Not supported

This is not commissioned for the treatment of relapsed/refractory ALL in patients <21 years of age


2011/2012


Prior approval

form available


Oncology Crizotinib N/A

Oncology Nelarabine N/A

Oncology Oxaliplatin N/A

Oncology Pegfilgrastim No

Oncology Rituximab N/A

Oncology Sorafenib N/A This is not commissioned for the treatment of metastatic thyroid cancer

Oncology N/A

Oncology Trabectedin N/A This is not commissioned for the treatment of relapsed ovarian cancer

Not supported

This is not commissioned for the second line treatment of non small cell lung cancer (NSCLC)


2011/2012

Not supported

This is not commissioned for the treatment of relapsed/refractory T-ALL / T-LBL


2011/2012

Not supported

This is not commissioned for the treatment of peritoneal carcinomatosis of the colorectal region


2011/2012


This is commissioned for FEC100/FEC-T prophylaxis in early breast cancer


2011/2012

Not supported

This is not commissioned for maintenance treatment for follicular non-Hodgkins lymphoma


2011/2012

Not supported


2011/2012

TCH (Taxotere (docetaxel),

Carboplatin, Herceptin (trastuzumab)

Not supported

This is not commissioned for the adjuvant treatment of HER2+ve breast cancer


2011/2012

Not supported


2011/2012


Prior approval

form available


Oncology Vandetanib N/A This is not commissioned for the treatment of metastatic thyroid cancer

Nuvaring No This contraceptive is commissioned on a prior approval basis

Oncology No

Neurology N/a

General Practice Fungal nail infeactions N/A

General Practice Hyperhidrosis N/A

Not supported


2011/2012

Obstetrics & Gynaecology



Statement No. 196

Retreatment with bortezomib for AL

amyloidosis


NHS Stockport commissions retreatment with bortezomib (Velcade ®) for AL amyloidosis for patients who had a good response to the previous treatment with bortezomib and would have a good quality of life if the amyloidosis was in remission


Statement No. 122

3,4 diaminopyridine (phosphate form) Firdapse ® when

generic supplies run out

NHS Stockport commissions the unlicensed DAP (base from) for Lambert-Eaton myasthenic syndrome and congenital myasthenic syndromes. Where there is a problem with supply of the DAP (base form) Firdapse may be substituted for patients gaining benefit from the DAP (base form) and for whom no other alternative treatment regimen will offer adequate benefit and where generic supplies have ran out.


Statement No. 112

Mar 2012 - The Group felt that this policy was not discriminatory.

Group approval

NHS Stockport only commissions treatment for fungal nail infections if the following criteria are met: the patient is immunocompromised; or the patient has peripheral vascular disease; or the patient is diabetic; or the nail is painful; or the patient is due to undergo surgery on that limb; AND there has been mycological confirmation. When Terbinafine is the drug of choice only oral terbinafine should be prescribed as topical terbinafine has inferior efficacy. Prescribers should ensure that they follow the British National Formulary (BNF) guidelines for monitoring patients and that patients do not continue treatment for longer than the recommended duration as outlined in The BNF.


Statement No. 92

Not supported

Whilst there is evidence of the effectiveness of treatment, including surgery and botulinum toxin injections, for hyperhidrosis, treatment of this condition is considered LOW PRIORITY and hence not commissioned.


Statement No. 31



Prior approval

form available


Oncology No

Ophthalmology N/A

Cardiology Aliskiren N/A

Cardiology Eplerenone N/A

Cardiology Ivabradine N/A

Cetuximab in non-metastasised

colorectal cancer


NHS Stockport commissions 3 months of cetuximab in wild-type KRAS colorectal cancer where the patient does not have any metastases, where the primary tumour needs to be reduced in size prior to surgery and where reducing the tumour size prior to surgery has the potential for the surgery to be a curative treatment


Statement No. 127


Dexamethasone implant (Ozurdex ®) for Diabetic Macular

Oedema (DMO)

Not supported

NHS Stockport does not commission the use of dexamethasone implant for Diabetic Macular Oedema owing to insufficient evidence of effectiveness


Statement No.128


Group approval

Specialist initiation only. In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of aliskiren (Rasilez®) for the treatment of hypertension only when recommended by a specialist for those high risk patients who are poorly controlled or cannot tolerate conventional antihypertensive agents i.e. used as a fourth line or subsequent antihypertensive drug after use or consideration of alpha-adrenoceptor blocking drugs (e.g. doxazosin), potassium-sparing diuretics and aldosterone antagonists (e.g. spironolactone)


Statement No.145


Group approval

In line with the GMMMG NTS guidance issued in January 2011 NHS Stockport commissions the use of eplerenone (Inspra®) in addition to standard therapy (including beta-blockers) to reduce the risk of cardiovascular mortality and morbidity in stable patients with LVSD (LVEF < or = 40%) and clinical evidence of heart failure after recent (in the last 14 days) myocardial infarction.


Statement No.133


Group approval

In line with the GMMMG NTS guidance issued in March 2011 NHS Stockport commissions the use of ivabradine (Procoralan ®) for use in chronic, systolic heart failure in patients in sinus rhythm for those patients who fulfill the same criteria as those used in the pivotal trial (i.e. LEVF <35% and a heart rate > 70bpm). This is commissioned when patients reach the optimum dose or maximum tolerated doses of betablockers/ACE inhibitors


Statement No.132



Prior approval

form available


Cardiology Ranolazine N/A

Endocrinology Tolvaptan No

General Practice N/A

Oncology Methylnaltrexone N/A

Nephrology Lanthanum carbonate N/A

Neurology Lacosamide N/A

Neurology Rivastigmine N/A

Group approval

In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of ranolazine (Latixa ®) for the treatment of stable angina pectoris only when initiated by a specialist for patients who are inadequately controlled on or intolerant of first line antianginal therapies and who are not suitable for surgical intervention.


Statement No.142



Specialist prescribing only.In line with the GMMMG NTS guidance issued in February 2010 NHS Stockport commissions the use of tolvaptan for the treatment of hyponatraemia caused by SIADH for adult patients who have frequent hospital admissions and in whom fluid restriction has failed


Statement No.129


Estradiol valerate and dienogest (Qlaira®)

Group approval

In line with the GMMMG NTS guidance issued in July 2009 NHS Stockport commissions the use of Estradiol valerate and dienogest (Qlaira®) combined oral contraceptive pill as a third line treatment option in those patients who cannot tolerate more established and cost effective combined oral contraceptives.


Statement No.149


Group approval

In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of methylnaltrexone (Relistor®) for the treatment of opioid-induced constipation where it is recommended by a palliative care specialist and standard maximal laxative therapy is ineffective.


Statement No.139


Group approval

Specialist initiation only. In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of lanthanum carbonate (Fosrenol®) for the treatment of hyperphosphataemia for patients receiving dialysis only after at least one calcium-based phosphate binding agent has been tried including consideration of the use of calcium acetate.


Statement No.148


Group approval

Initiation by a Specialist only. In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport commissions the use of lacosamide as a third or fourth line treatment option after more established therapies for partial-onset seizures.


Statement No.138


Group approval

In line with the GMMMG NTS guidance issued in February 2010 NHS Stockport commissions the use of rivastigmine for the management of dementia with Lewy bodies for those patients who have non-cognitive symptoms causing significant distress to the individual (e.g. hallucinations) or leading to challenging behaviour.


Statement No.136



Prior approval

form available


Neurology Rotigotine N/A

Neurology Rufinamide N/A

Paediatrics Risperidone N/A

Respiratory Micafungin N/A

Rheumatology Metoject N/A

Urology Fesoterodine N/A

Group approval

Specialist initiation only. In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of rotigotine transdermal patches (Neupro®) for the treatment of early stage idiopathic Parkinson’s disease and in combination with levodopa in the later stages of Parkinson’s disease for patients in whom oral dopamine agonists are ineffective or for patients with swallowing problems.


Statement No.146


Group approval

Specialist initiation only. In line with the GMMMG NTS guidance issued in June 2010 NHS Stockport commissions the use of rufinamide in patients with Lennox-Gastaut syndrome (LGS), aged four years and older, who have failed treatment with or are intolerant of alternative traditional antiepileptic drugs.


Statement No.134


Group approval

In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of risperidone for paediatric patients with learning difficulties or autism-spectrum disorders provided that use is in accordance with the guidance issued by the Child and Adolescent Mental Health Service at Central Manchester & Manchester Children’s University Hospitals NHS Trust.


Statement No.143


Group approval

In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of micafungin (Mycamine®) for the treatment of invasive candidiasis for patients that have failed standard antifungal therapy. Micafungin should be used in line with the treatment protocols available from the University Hospital of South Manchester NHS Foundation Trust.


Statement No.141


Group approval

Specialist initiation only. In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport commissions the use of Metoject® for the treatment of moderate to severe rheumatoid arthritis for patients in whom parenteral methotrexate is indicated.


Statement No.140


Group approval

In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport commissions the use of fesoterodine for the treatment of symptoms associated with overactive bladder syndrome in patients who do not achieve an improvement with immediate release oxybutynin.


Statement No.137



Prior approval

form available


Urology Histrelin No

Respiratory No

Psychiatry N/A

General Practice N/A

Rheumatology Yes

Ophthalmology No

Dermatology No

Group approval

Prior Approval for initiation in primary care. In line with the GMMMG NTS guidance issued in March 2011 NHS Stockport commissions the use of histrelin subcutaneous implant for the palliative treatment of advanced prostate cancer in those patients with an anticipated life expectancy of at least one year and in whom annual administration will offer an advantage


Statement No.131


Indacterol (OnBrez®) for COPD

Group approval

In line with the GMMMG NTS guidance issued in March 2010 NHS Stockport commissions the use of indacterol for the treatment of chronic obstructive pulmonary disease for patients in whom a long acting β-adrenoceptor agonist (LABA) is considered suitable.


Statement no 135


Methylphenidate in adults

Group approval

In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport does not commission the initiation of methylphenidate for attention-deficit-hyperactivity disorder in adults. Where this condition is identified and this treatment is considered appropriate this will be managed via prior approval through the individual funding request process. Methylphenidate is commissioned for attention-deficit-hyperactivity disorder in adults as a continuation of adolescent therapy.


Statement No.144

Mar 2012 - The Group felt that this policy was not discriminatory as patients follow an appropriate pathway

Probiotics for ulcerative colitis

Not supported

NHS Stockport does not commission probiotics for ulcerative colitis as although they are as clinically effective as the current standard treatment they are more costly


Statement No.151


Rituximab for Wegener’s

granulomatosis


Rituximab is commissioned by NHS Stockport for patients with Wegener’s granulomatosis who have failed to respond to all other conventional treatments or in whom the conventional treatments are contraindicated


Statement No. 72


Dexamethasone implant (Ozurdex ®) for macular oedema resulting from uveitis


NHS Stockport commissions dexamethasone implant (Ozurdex ®) for the treatment of macular oedema resulting from uveitis, on an individual patient basis


Statement No. 159


Omalizumab for severe chronic

urticaria

Not supported

NHS Stockport does not commission omalizumab for severe chronic urticaria owing to the limited evidence available of this intervention’s effectiveness and cost effectiveness for this indication


Statement No. 158



Prior approval

form available


General Practice Vitamin D No

Rheumatology N/A

Not supported

High dose vitamin D should not be initiated in primary care for patients under the care of Stockport NHS Foundation Trust. High dose vitamin D may be initiated in primary care following a recommendation from a secondary care clinician based in a hospital other than Stepping Hill. Treatment with vitamin D following vitamin D testing is covered in LPS 114 Vitamin D testing. The following groups are at risk of vitamin D deficiency: All pregnant and breastfeeding women, especially teenagers and young women; Infants and young children under 5 years of age; Older people aged 65 years and over; People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods; People who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. People in the above categories should be encouraged to purchase over the counter supplements unless they are eligible for Health Start vitamins and should not be prescribed on the NHS

NHS Stockport Local Policy Statement No.114a

Mar 2012 - The Group felt that this policy was not discriminatory as

patients were advised to but over the counter and if they were on

benefits then they could receive them under the appropriate scheme.

Zoledronic acid for osteoporosis

Group approval

In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of zoledronic acid (Aclasta®) infusion for the treatment of post-menopausal osteoporosis only for those patients intolerant of oral bisphosphonate drugs or with established compliance or swallowing problems


Statement No.147



Prior approval

form available


Dermatology No

Rheumatology No

Haematology Eculizumab N/A

Ophthalmology No

Infliximab or adalimumab for

hidradenitis suppurativa


Infliximab and Adalimumab are commissioned on an individual patient basis for the treatment of hidradenitis suppurativa with the following restrictions: The condition is refractory to or the patient is unable to tolerate commonly used first and second line treatments including self-care, antibiotics (most commonly rifampicin and clindamycin), Roaccutane®, corticosteroids and immunosuppressants (cyclosporine, azathioprine and methotrexate); AND The patient has a DLQI of greater or equal to 21; AND The patient has a GHQ12 score>15 (or >20 and all systemic agents not used in that patient); AND The patient has had one or more admissions to control symptoms in the last 12 months; AND Surgical options have been considered; AND The patient has been counselled (and this is clearly documented) about potential adverse effects of the drug treatment. It is expected that treatment using infliximab or adalimumab will be funded for a trial period of 4 months, with continuation of funding being agreed only if the patient responds adequately. Routine funding will then continue until the patient loses response.


Statement No.163


Sildenafil for systemic sclerosis with severe

Raynaud's phenomenon


NHS Stockport commissions sildenafil for patients with severe Raynaud’s phenomenon secondary to systemic sclerosis on a prior approval basis


Statement No.164


Not supported

NHS Stockport does not commission eculizumab for indications other than paroxysmal nocturnal haemoglobinuria (including antibody-mediated rejection, Guillain-Barre Syndrome, atypical haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE)) because the use of eculizumab in these conditions is considered to be experimental.


Statement No.161

IVIG for MAR (melanoma associated

retinopathy)


This treatment is commissioned on an individual patient basis as there is limited published evidence of effectiveness.


Statement No. 40


Prior approval

form available


Capsaicin patch N/A

Haematology No

Oncology Plerixafor No

Gastroenterology Colesevelam N/A

General Practice Omacor N/A

Haematology Erythropoietin N/A

Neurology Alemtuzumab No

Pain management

Group approval

NHS Stockport commissions capsaicin patch (Qutenza®) where the following criteria are met: the patient has severe, non-diabetic neuropathic pain unresponsive to multimodal neuropathic analgesics; the patient’s pain significantly impairs activities of daily living as demonstrated on the Brief Pain Inventory; and the patient is under the care of a specialist pain clinic.


Statement No. 167

May 2012 - The Group felt that this policy was not discriminatory.

Rituximab for AIHA (Autoimmune

haemolytic anaemia)


This is commissioned for patients with refractory autoimmune haemolytic anaemia at the lowest clinically effective dose. For appropriate patients, rituximab should be considered before treatment with IVIg.


Statement No. 55

June 2012 - The Group felt that this policy was not discriminatory.


Plerixafor is commissioned by NHS Stockport in patients requiring stem cell mobilisation prior to an autologous stem cell transplant, where: there was insufficient stem cell mobilisation with G-CSF; and the stem cell transplant is a standard treatment for the type and severity of disease the patient has.


Statement No. 71

June 2012 - The Group felt that this policy was not discriminatory.

Not supported

NHS Stockport does not commission colesevelam for bile acid malabsorption owing to a lack of evidence of superiority over the current standard treatment of colestyramine.


Statement No. 207

Aug 2012 - The Group felt that this policy was not discriminatory.

Not supported

In line with the GMMMG NTS guidance issued in May 2012 NHS Stockport does not commission Omacor® for the secondary prevention of myocardial infarction.


Statement No. 206


Not supported

NHS Stockport does not commission erythropoietin for anaemia associated with myeloma owing to inadequate evidence of cost effectiveness


Statement No. 201

Jul 2012 - The Group felt that this policy was not discriminatory.


In line with the GMMMG Neurosciences Medicines Management group guidance issued in May 2012 NHS Stockport commissions alemtuzumab for multiple sclerosis for patients: with rapidly evolving severe (RES) multiple sclerosis; who have failed on licensed natalizumab (Tysabri®), fingolimod (Gilenya®) or unlicensed mitoxantrone; and where the treatment will be initiated by a consultant neurologist with a special interest in multiple sclerosis.


Statement No. 205



Prior approval

form available


Ophthalmology Idebenone N/A

Endocrinology Linagliptin

ENT Pollinex® Quattro N/A

Rifaximin N/A

Fidaxomicin

Not supported

NHS Stockport does not commission idebenone for Leber’s hereditary optical neuropathy, where both eyes have poor vision, owing to inadequate evidence of efficacy.


Statement No. 208


In line with the GMMMG NTS guidance issued in September 2011 NHS Stockport commissions linagliptin as an option for the treatment of type 2 diabetes to improve glycaemic control in adults; as monotherapy, in combination with metformin or in combination with metformin and a sulphonylurea; in those patients who fulfill the criteria for a DDP-4 inhibitor as per NICE Clinical Guideline CG87. The DDP-4 inhibitor with the cheapest acquisition cost should be used first line; however linagliptin may be a suitable choice in those patients with renal impairment.


Statement No. 210

Sep 2012 - The Group felt that this policy was not discriminatory.

Not supported

In line with the GMMMG NTS guidance issued in July 2012 NHS Stockport does not commission Pollinex® Quattro subcutaneous vaccine for the treatment of seasonal allergic rhinoconjunctivitis


Statement No. 217


General Medicine / General Practice

Not supported

In line with the GMMMG NTS guidance issued in June 2012 NHS Stockport does not commission rifaximin (Xifaxanta®▼) for the treatment of travellers’ diarrhoea (licensed indication) or for the treatment of Clostridium Difficile infection (unlicensed indication).


Statement No. 215


General Medicine / General Practice

In line with the GMMMG NTS guidance issued in June 2012 NHS Stockport commissions fidaxomicin (Dificlir®▼) as a treatment option following a second relapse, i.e. as third line therapy, of Clostridium Difficile infection. Fidaxomicin should be initiated by a microbiologist or under microbiologist recommendation and is not to be prescribed in primary care


Statement No. 216



Prior approval

form available


N/A

Psychiatry Asenapine

Pain management

Tapentadol (Palexia®) immediate and

prolonged release

Not supported

In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport does not commission tapentadol (Palexia®) immediate and prolonged release for the treatment of acute and chronic severe pain


Statement No. 209

Sep 2012 - The Group recognised the impact this policy will have on patients with long-term

conditions, who are protected under the

characteristic of disability in the Equality Act. However, as the decision was taken

primarily on the grounds of clinical effectiveness and health benefits to patients the Group has agreed that this does

not amount to discrimination.

In line with the GMMMG NTS guidance issued in March 2012 NHS Stockport commissions asenapine as a treatment option for the treatment of manic episodes in adults with bipolar I disorder as per Mental Health Trust recommendations as part of an in-patient treatment regimen for the acute phase only. Asenapine for the treatment of manic episodes in adults with bipolar I disorder is not to be prescribed in primary care.


Statement No. 213







Prior approval

form available


Psychiatry N/A

Rheumatology Belimumab

Paliperidone depot injection

Not supported

In line with the GMMMG NTS guidance issued in January 2012 NHS Stockport does not commission paliperidone depot injection (Xeplion®) for schizophrenia


Statement No. 212






In line with the GMMMG NTS guidance issued in March 2012 NHS Stockport commissions belimumab for SLE for patients: with 4 or more American College of Rheumatology criteria for SLE; ANA or dsNDNA positive at the time of assessment; with active disease (SLEDAI of 6 or more or 1 BILAG A or 2 BILAG B); with positive dsDNA or low complement; with not a predominant renal or CNS flare; AND not eligible for a clinical trial. Initiation of belimumab is restricted to tertiary specialist clinicians; this may involve direct initiation or the advice to initiate following assessment of patient after referral. Discontinuation of belimumab should be considered if there is no improvement in disease control after 6 months of treatment.


Statement No. 214







Prior approval

form available


Urology Degarelix

General Practice Insulin degludec N/A

In line with the GMMMG NTS guidance issued in November 2011 NHS Stockport does not commission the routine use of degarelix for the treatment of hormone dependent advanced prostate cancer. However it may be a valuable treatment option in those patients who are particularly vulnerable to the clinical effects of a testosterone flare. These patients may include those: (a) at risk of neurological compromise due to metastases, (b) with urethral or bladder outlet obstruction due to local encroachment or metastatic disease.


Statement No. 211

Sep 2012 - The Group recognised the impact

this policy will a differential impact on

men who are protected under the characteristic

of sex in the Equality Act. However, as the decision was taken



Not supported

In line with the GMMMG NTS guidance issued in July 2012 NHS Stockport does not commission insulin degludec (Tresiba®▼) for the treatment of diabetes mellitus (Type 1 and Type 2) where insulin is required.


Statement No. 218

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence suggests this intervention is no more effective than alternatives


Prior approval

form available


General Practice Zostavax N/A

Haematology Deferasirox No

Urology Yes

Not supported

NHS Stockport does not commission Zostavax for the prevention of shingles in adults aged over 50 outside of the national vaccination programme.


Statement No. 221

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of age, but did not discriminate as the clinical evidence supports the policy decision


In line with GMMMG guidance issued in October 2007 NHS Stockport commissions oral iron chelators as first-line in patients aged over 6 years with beta thalassaemia major for chronic iron overload due to frequent blood transfusions; second-line in iron overload in patients with beta thalassaemia major, requiring infrequent blood transfusions and in patients with other anaemia’s including sickle cell patients and patients aged 2-5 years, when desferrioxamine therapy is not tolerated, contraindicated or inadequate. NHS Stockport does not commission oral iron chelators as first-line for the treatment of iron overload in patients with refractory anaemias (myelodysplastic syndromes, aplastic anaemia, myelofibrosis, red cell aplasia)


Statement No 109

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of ethnicity, but did not discriminate as the clinical evidence supports the policy decision

Botulinum for Urinary Incontience


This treatment is commissioned on an individual basis, for adults and children, where urinary incontinence results from idiopathic or neurogenic detrusor overactivity, which is refractory to treatment with anticholinergics. This treatment is commissioned on an individual basis, for adults and children, with spinal cord disease and with urodynamic investigations showing impaired bladder storage and in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated.


Statement No. 15

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence supports the policy decision.


N/A Jun-09

Not supported N/A Jun-09

Audiology Yes Jun-09

Cardiology Not supported N/A Jun-09

Colorectal Yes Jun-09

Dental Wisdom teeth Yes NICE TA 1

Dermatology N/A Jun-09

Dermatology Not supported N/A Jun-09



Prior approval

form available


Out of Area treatments Position statement

Requests for referral to an ineligible out of area service/provider will be considered on an individual basis in certain cases.


Statement No. 24


therapies

Hypnotherapy for Irritable Bowel (IBS)

This therapy Is considered LOW PRIORITY. Hypnotherapy for the treatment of IBS is not commissioned due to insufficient evidence of effectiveness


Statement No. 16

Bone Anchored Hearing Aid


Commissioned on a individual patient basis NHS Stockport Local Policy

Statement No. 87

Enhanced External Counterpulsation

(EECP)This procedure is considered to be experimental and is not commissioned.


Statement No. 173

Sacral Nerve Modulation for faecal

incontinence


NHS Stockport commissions sacral nerve modulation for faecal incontinence where there is an intact anal sphincter AND severe incontinence of liquid or solid faeces AND an unsatisfactory response to all appropriate non-surgical treatments and any previously attempted surgical ones AND a satisfactory response to a test procedure.


Statement No. 20

Prior approval - CCC

NHS Stockport will only fund wisdom teeth extraction for patients meeting the criteria in NICE TA1

Dermatology Minor surgery (for cosmetic

and benign skin lesions)

Group approval

Dermatological procedures that are purely cosmetic in nature are considered LOW PRIORITY and hence not commissioned. Lipomas and sebaceous cysts that may be painful of become infected are not defined as cosmetic for these purposes. Removal of skin lesions within secondary care will only be considered if: lesions are suspicious or potentially malignant; there is impairment of function or significant facial disfigurement.


Statement No. 3 & No. 22

Epilation of facial hair in males

Epilation of facial hair in males is considered LOW PRIORITY and is not commissioned. An exception is made for males with severe pseudofolliculitis who can not reduce their frequency of shaving, for example, firemen who need to be close shaved to allow proper fitting of their airway masks.


Statement No. 4n

Hyperhidrosis - surgery or botulinum

toxin injections

These therapies are considered LOW PRIORITY. Treatment of hyperhidrosis with surgery or botulinum toxin injections is not commissioned.


Statement No. 31

Laser treatment for acne scarring

This treatment is considered LOW PRIORITY. Laser treatment for acne scarring is not commissioned


Statement No. 4


Prior approval

form available


Dermatology Tattoo removal Not supported N/A Jun-09

ENT Yes Jun-09

ENT Sinus x-ray Not supported N/A X-rays of sinuses are not routinely commissioned Jun-09

ENT Yes Jun-09

ENT Not supported N/A Jun-09

Yes Jun-09

Screening test Not supported N/A Jun-09

NHS Stockport will consider removal of tattoos in the following cases: where the tattoo is the result of trauma, inflicted against the patient’s will (“rape tattoo”); the patient was not Gillick competent, and therefore not responsible for their actions, at the time of the tattooing; exceptions may also be made for tattoos inflicted under duress during adolescence or disturbed periods where it is considered that psychological rehabilitation, break up of family units or prolonged unemployment could be avoided, given the treatment opportunity. (Only considered in very exceptional circumstances where the tattoo causes marked limitations of psycho-social function).


Statement No. 4h

Grommets/Surgical Treatment of Otitis

Media


Children should meet one of the following criteria: Persistent bilateral OME with a hearing level in better ear of 25–30 dBHL or worse confirmed over 3 months; or persistent bilateral OME with hearing loss less than 25–30 dBHL and significant impact on child’s developmental, social or educational status.


Statement No. 171


Statement No. 172

Surgical treatment for sleep apnoea


Treatment is available at South Manchester, however all patients should be referred by a chest physician before being referred for treatment and not referred directly to South Manchester


Statement No. 11

Surgical Treatment for Snoring

Treatment solely for snoring is considered LOW PRIORITY. The PCT will not normally fund treatment when snoring is the sole problem. Only snorers with at least one of the following symptoms present should be referred for assessment for sleep apnoea: daytime sleepiness, not just tiredness (Epworth Sleepiness Score >9); witnessed regular or frequent episodes, as opposed to occasional, of stopping breathing during sleep; waking from sleep with choking / obstructed episodes; regular waking feeling unrefreshed; large neck circumference (17 inches or over) or significant retrognathism; small oedematous pharynx on visual inspection.


Statement No. 11a

Gastroenterology

Wireless Capsule Enteroscopy for

Investigation of the Small Bowel


This investigation is commissioned on an individual basis in line with NICE guidance where patients meet one of the following criteria for investigation: Overt or transfusion dependent bleeding from the GI tract, when the source was not identified on OGD and colonoscopy; Crohn’s disease; or Hereditary GI polyposis syndromes.


Statement No. 9

General Practice

Tests for employment medicals and paternity testing are not commissioned as they are low priority. Patient requests for screening tests outside of national programmes should only be done when clinically indicated


Statement No. 35


Prior approval

form available


General Surgery Varicose veins Yes Jun-09

Haematology No This treatment is commissioned on an individual patient basis Jun-09

N/A Jun-09

Minor Surgery Not supported N/A Jun-09

Neurology No Jun-09

Neurology No Commissioned on a individual patient basis Jun-09

Neurology No Commissioned on a individual patient basis Jun-09


NHS Stockport funds referral to a specialist service for patients in whom varicosities are present or suspected in the following circumstances: they are bleeding from a varicosity that has eroded the skin; they have bled from a varicosity and are at risk of bleeding again; they have an ulcer which is progressive and/or painful or they have a stable, pain-free, ulcer and/or progressive skin changes that may benefit from surgery / sclerotherapy.


Statement No. 2

Extracorporeal photopheresis for

GvHD



Statement No.45

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy

Notified approval

This treatment is commissioned for decompression illness, gas embolism and carbon monoxide poisoning in patients at high-risk of immediate or long-term complications. This treatment is not commissioned for diabetic lower extremity ulcers, venous ulcers, pressure ulcers, other chronic wounds, crush injuries, blunt chest injury, acute ophthalmological ischaemia, grafts and flaps, necrotising soft-tissue infections,surgical site infections, livedoid vasculopathy, acute coronary syndrome, stroke, traumatic brain injury, soft tissue radionecrosis, osteoradionecrosis, cancers and tumour sensitisation to radiotherapy, chronic refractory osteomyelitis, surgery, cardio-pulmonary bypass, urology, headache, multiple sclerosis, thermal burns, sports injuries, osteonecrosis of the mandible, peridontitis, chronic hepatitis, Crohn’s disease, Bells palsy, pain syndromes, cognitive impairment, calciphylaxis, infertility, severe anaemia and malignant otitis externa.


Statement No.44

Removal of Haemorrhoidal Skin

Tags

This procedure should not be performed. There may be consideration of special circumstances e.g. recurrent bleeding


Statement No.174

Specialist epilepsy services


Some specialist epilepsy services are commissioned on an individual basis. A maximum of one week for videotelemetry and one week for assessment will be commissioned. Other specialist epilepsy services are not commissioned, including residential care.


Statement No. 12

Functional electrical stimulation for dropped foot



Statement No. 32

Functional electrical stimulation for facial

palsy



Statement No. 175


Prior approval

form available


Neurology Yes Commissioned on an individual basis in line with NICE guidance (IPG050) Jun-09


N/A Jun-09

No Jun-09

Oncology MUD No Approved on an individual basis according to certain criteria. Jun-09

Oncology N/A Jun-09

Vagal nerve stimulators for

epilepsy



Statement No. 30


Diagnostic Dilation and Curettage for

Women <40

This procedure should only be undertaken in exceptional circumstances as risk of anaesthesia, uterine perforation and cervical laceration have been identified in Effective Healthcare Bulletin 9 as outweighing the minimum potential benefit. In the investigation of dsyfunctional uterine bleeding, hysteroscopy with selected biopsy or curettage is superior to routine dilatation and curettage


Statement No. 7


Hysterectomy (abdominal and

vaginal)

Group approval

Hysterectomy should only be undertaken if patients have followed the map of medicine pathway, or are on a cancer referral pathway


Statement No. 176


Vaginal ring pessaries in secondary care

Prior approval - CCC with reference to EUR team

Replacement of vaginal ring pessaries should be undertaken out of hospital by a GP or the tier 2 service. A patient may be referred to secondary care if replacement is difficult.


Statement No. 177



Statement No. 178

Positron Emission Tomography (PET)

scans

Group approval

This is commissioned for certain clinical indications, namely: staging of non-small cell lung cancer prior to surgery or radical radiotherapy; a ssessment of solitary pulmonary nodule ONLY when biopsy not safe or practicable; re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs; re-staging of colon cancer following surgery and radiotherapy; initial & re-staging of Hodgkin’s Lymphoma; initial & re-staging of diffuse large B-cell lymphoma; staging of oesophageal cancer prior to radical surgery; assessment for malignant neck nodes from unknown primary site in head and neck; re-staging of suspected recurrent non-CNS head & neck cancer following surgery or radiotherapy; re-staging of thyroid cancer – serum thyroglobulin raised & radio-iodine imaging negative; Staging of malignant melanoma prior to radical surgery for localized or metastatic disease. Diagnosing an unknown primary where there are no secondary metastases but which has caused a paraneoplastic syndrome .


Statement No. 49


Prior approval

form available


Ophthalmology Not supported N/A Jun-09

Ophthalmology Not supported N/A Jun-09

Paediatrics No Jun-09

Plastic Surgery Yes Jun-09


Plastic Surgery Not supported N/A Jun-09



Intraocular telescope for age-related

macular degeneration

This is not commissioned as there is limited published evidence of effectiveness.


Statement No. 36

Surgery for Short Sight

This is considered LOW PRIORITY and hence not commissioned. This includes laser correction of short sightedness; and insertion of intraocular lens for correction of refractive error.


Statement No. 39

Nocturnal Non-Invasive Ventilation for

Muscular Dystrophy


This treatment will be reviewed on an individual basis where patients’ blood CO2 levels are high enough.


Statement No. 18

Bleopharoplasty upper lid (Surgery on the

upper eyelid)


This procedure will be commissioned to correct functional impairment (not purely for cosmetic reasons) as demonstrated by: impairment of visual fields in the relaxed, non-compensated state; or clinical observation of poor eyelid function, discomfort, e.g. headache worsening towards end of day and/or evidence of chronic compensation through elevation of the brow


Statement No. 4d

Bleopharoplasty lower lid (Surgery on the

lower eyelid)


This is available for correction of ectropion or entropion or for the removal of lesions of the eyelid skin or lid margin.


Statement No. 4e

Revision of breast augmentation

Revisional surgery will only be considered if the NHS commissioned the original surgery. If revisional surgery is being carried out for implant failure, the decision to replace the implant(s) rather than simply remove them should be based upon the clinical need for replacement and whether the patient meets the policy for augmentation at the time of revision


Statement No. 4b

Rhinoplasty (Surgery to reshape the nose)


Rhinoplasty should be available for: problems caused by obstruction of the nasal airway; objective nasal deformity caused by trauma; correction of complex congenital conditions e.g. Cleft lip and palate; patients with isolated airway problems (in the absence of visible nasal deformity) may be referred initially to an ENT consultant for assessment and treatment.


Statement No. 4f

Rhytidectomy (Face lifts and brow lifts)


These procedures will be considered for treatment of: congenital facial abnormalities; facial palsy (congenital or acquired paralysis); as part of the treatment of specific conditions affecting the facial skin e.g. cutis laxa, pseudoxanthoma elasticum, neurofibromatosis; to correct the consequences of trauma; to correct deformity following surgery.


Statement No. 4c


Prior approval

form available


Plastic Surgery Split ear lobes Not supported N/A Jun-09

Psychiatry Gender Dysphoria No Jun-09

Respiratory Cough Assist Machine No New equipment is commissioned if there are no machines available. Jun-09


Not supported N/A This procedure is considered to be experimental and is not commissioned Jun-09

Not supported N/A This procedure is not commissioned Jun-09


Urology No Jun-09

Urology Not supported N/A This is not commissioned as there is limited evidence of effectiveness. Jun-09

Repair of split ear lobes will not normally be commissioned even when the split ear lobe is the result of trauma.


Statement No. 4i


Treatment for gender dysphoria via gender reassignment is a low priority and will only be agreed in accordance with the referral criteria and collaborative commissioning arrangements. Patients with gender dysphoria should be registered with a Stockport GP Practice. Referrals for gender reassignment will only be made through the NHS general psychiatrist in Stockport with the support of the patient’s GP.


Statement No. 6



Statement No. 179

Trauma & Orthopaedics

Endoscopic Lumbar Decompression

This treatment will not be routinely commissioned but funding will be considered for endoscopic lumbar decompression as part of peer reviewed randomised control trials that compare endoscopic laser foraminoplasty to either conservative therapy or to conventional surgery such as spinal fusion.

Greater Manchester

Evidence Review No. 13


Femoroacetabular (hip) impingement

surgery


Statement No. 47


TAMARS (Technology Assisted

Micromobilisation and Reflex Stimulation)


Statement No. 48


Treatment at the Spinal Foundation

These services are rarely commissioned and only as part of an approved randomised controlled trial.


Statement No. 13

Artificial urinary sphincter


This procedure is an established treatment that is rarely performed. This procedure is commissioned on an individual patient basis.


Statement No. 180

ESWT (Extracorporeal Shockwave Therapy)

for prostadynia or pelvic floor syndrome


Statement No. 52


Prior approval

form available


Urology Not supported N/A This is not commissioned as there is limited evidence of effectiveness Jun-09

Urology Yes Jun-09

Urology No Jun-09


Allergy Breakspear Hospital Not supported N/A Services at the Breakspear Hospital are not commissioned Sep-09

Diagnostics Not supported N/A Sep-09

Donor insemination Not supported N/A Donor insemination is not funded Sep-09

Hyperthermia treatment for

prostadynia or pelvic floor syndrome


Statement No. 53

Sacral Nerve Modulation


This treatment is usually commissioned on an individual basis for patients in one or more of the following categories: individuals with urinary urge incontinence where conventional treatment has failed; individuals with urgency-frequency where conventional treatment has failed.


Statement No. 20

Vasectomy in secondary care setting


Provision of vasectomy should only be undertaken in a primary care setting, it is not commissioned as a secondary care service. However it is noted that referral to secondary care may be required in some circumstances e.g. GA for needle phobics.


Statement No. 181

Vascular Surgery

Chelation Therapy for Vascular Occlusions

This treatment is a medical alternative to surgery for treatment of vascular occlusions. Clear evidence will have to be presented that the type of intervention is clinically effective before it is supported.

Greater Manchester



Statement No. 54

Direct access to open MR scanner

This is not commissioned. Patients who cannot tolerate or whose BMI precludes a normal MR scan should be referred directly to the preferred secondary care provider as other diagnostic tests may be available in the secondary care settting.


Statement No. 182



Statenment No. 82


Prior approval

form available


Plastic Surgery Yes Feb-10

Not supported N/A Feb-10

N/A Feb-10

Apronectomy / abdominoplasty


Funding for apronectomy / abdominoplasty will only be considered when the patient : has excess abdominal skin as the result of significant weight loss; and has had a body mass index (BMI) of less than 30 for a minimum of 12 months; and the abdominal skin hangs below the symphysis pubis when standing; and there are clinical symptoms, for example: intertrigo or other chronic persistent / recurrent skin condition that is refractory to good hygiene and medical management, severe impairment of functionality (e.g. ambulatory restrictions) that an appropriately trained clinician (i.e. doctor, physiotherapist or occupational therapist) has documented is likely to be alleviated following surgery or problems associated with poorly fitted stoma bags that an appropriately qualified clinician (i.e. doctor or stoma nurse) has documented are likely to be alleviated following surgery. Patients meeting these criteria will be assessed by the Plastic Surgeons at South Manchester University Hospitals NHS Trust and only those cases approved by that team will be funded.


Statement No. 4l


therapies


therapies

Therapies included in this section are considered LOW PRIORITY. Included in this section is: 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 as stand alone services. Acupuncture is available within some musculoskeletal care pathways.


Statement No. 8


Elective Caesarean section

Group approval

Intervention approved according to criteria established in guidelines issued jointly by NICE and National Collaborating Centre for Women’s and Children’s Health. Planned caesarean section should only be routinely offered to women with: a term singleton breech (if external cephalic version is contraindicated or has failed), a twin pregnancy with breech first twin, HIV (only if recommended by a HIV consultant), both HIV and hepatitis C (as above, there is no evidence that CS should be performed for hepatitis C alone), primary genital herpes in the third trimester (active genital herpes at the onset of labour), grade 3 and 4 placenta praevia, two previous caesarean sections or more, previous upper segment caesarean section or type unknown, previous significant uterine perforation/surgery breaching the cavity.

Greater Manchester



Prior approval

form available


Audiology Not supported N/A

Not supported N/A

Dermatology Yes Feb-10

Sequential cochlear implant

Greater Manchester PCTS have agreed that for sequential cochlear implants, approval will only be given for those cases that are considered to be exceptional, rather than those cases whom the clinical team considers will obtain sufficient benefit.


Statement No. 62

Nov-09 Age restriction applies but this is in line with NICE guidance

General Practice

Direct access barium enema

Direct access barium enema is only available with prior approval from the EUR team. The reason for this is that barium enema is indicated for: suspected colorectal cancer. However these patients should be referred to a colorectal or anal cancer to a team specialising in the management of lower gastro-intestinal cancer as per the NICE CG27: referral for suspected cancer. These guidelines also state that when referring, no examinations or investigations other than abdominal and rectal examination and full blood count are recommended as this may delay referral; suspected diverticulitis. However other investigations such as colonoscopy and CT scan should be considered first; suspected inflammatory bowel disease. However the investigation of suspected inflammatory bowel disease should be lead by a specialist; treatment of some conditions, such as intersusseption. However the treatment of these conditions with barium enema should be initiated by a specialist. Barium enemas deliver a high radiation dose (equivalent to over 250 chest X-rays)


Statement No. 69

Cutaneous and plantar warts


Warts normally resolve spontaneously although this may take up to 2 years. Treatment for warts should only be considered if warts: are symptomatic i.e. painful or itchy; or interfere with functioning; or have been present for more than two years; or have spread extensively. Treatment should initially be by duct tape occlusion, if this is unsuccessful then treatment with topical salicylic acid should be considered. Treatment with cryotherapy should only be considered if treatment with both duct tape occlusion and topical salicylic acid has not cleared the wart. Referral to the tier 2 dermatology service should only be considered if: there is genuine doubt about the diagnosis; or the wart is recalcitrant or rapidly growing; or malignancy is suspected (malignant changes in warts are extremely rare but should be excluded in older people or people with immunosuppression or subungual warts.)


Statement No. 68


Prior approval

form available


Yes

Minor Surgery No Mar-10

Minor Surgery Yes Mar-10

Not supported N/A Feb-10

Plastic Surgery Labiaplasty Not supported N/A Mar-10

Obstetrics & gynaecology

Pre-implantation genetic diagnosis

(PIGD)


PIGD will be funded for those couples meeting the following criteria: the genetic condition is included on the list of conditions licensed for PIGD by the Human Fertilisation and Embryology Authority (HFEA); the female partner is aged between 23 and 39 years old at the time of treatment; the female partner’s BMI is between 19-29; both partners are non-smokers; both partners can give assurance that alcohol intake is within Department of Health guidelines and they are not using recreational drugs; neither partner has previously undergone a sterilisation procedure. One cycle of PIGD will be funded, if a live birth is not achieved from this one cycle, one further cycle will be funded.


Statement No. 67

Feb-10 whether this policy discriminated against couples requiring IVF to conceive who already had a child (and therfore are ineligible for IVF on the NHS) was considered but it was felt that this was a policy for different indication and therefore it was not discriminatory

Surgery for ingrown toenails in secondary

care


Surgery for ingrown toenails is not routinely commissioned in a secondary care setting. Surgery for ingrowing toenails may be performed in secondary care when future orthopaedic surgery would be compromised. For example, a recurrently infected ingrowing toe nail requiring treatment prior to joint replacement surgery. Referral to secondary care for failed primary care management requires prior approval from the EUR team.


Statement No. 183

Dermatology Minor surgery (for cosmetic

and benign skin lesions)


Dermatological procedures that are purely cosmetic in nature are considered LOW PRIORITY and hence not commissioned. Lipomas and sebaceous cysts that may be painful of become infected are not defined as cosmetic for these purposes. Removal of skin lesions within secondary care will only be considered if: lesions are suspicious or potentially malignant; or there is impairment of function or significant facial disfigurement. Lipoma over 15cm in size are at risk of being malignant and should be sent on a 2 week pathway proforma. Under no circumstances should a biopsy/excision of lipomas over 15cm in size be undertaken by anyone who is unable to perform / coordinate a compartmental resection if required.


Statement No. 3 & No. 22

General Practice

Direct access to barium enema

Direct access barium enema is only available with prior approval from the EUR team


Statement No. 69

This procedure is considered to cosmetic and hence low priority. NHS Stockport does not commission labiaplasty / labioplasty


Statement No. 4p


Prior approval

form available


policy position N/A

Knee Arthroscopy Yes Mar-10

Ear irrigation N/A May-10

ENT Yes May-10

Local risk sharing schemes between a

hospital, NHS Stockport and the

manufacturer of the drug to give patients access to a drug that would otherwise not be commissioned on

cost-effectiveness grounds.

Risk sharing schemes are a way of reducing the overall cost of a drug for a specific disease, through a special agreement with the manufacturer. On a national scale, risk sharing schemes (also known as patient access schemes) exist between the Department of Health and pharmaceutical manufacturers for NICE approved technologies (TAs). A local risk sharing scheme is an agreement between a hospital, its PCT and the manufacturer of the drug, used to give patients access to a drug that would otherwise not be commissioned on cost-effectiveness grounds. NHS Stockport will not enter into local risk sharing schemes.


Statement No. 66



Diagnostic knee arthroscopy should not be carried out for the investigation of knee pain unless an MR scan is contraindicated (e.g. because of foreign body in the eye, pacemaker or cerebral clips) Therapeutic knee arthroscopy may be used for the following where conservative measures have failed or unlikely to be effective: removal of loose body, meniscal surgery (repair or resection), ligament reconstruction/repair (including lateral release), synovectomy, treatment of localised chondral lesions. Knee arthroscopic washout alone should NOT be carried out for the treatment of osteoarthritis


Statement No. 184

General Practice

Group approval

NHS Stockport commissions ear irrigation for: removal of a foreign body from the ear canal; removal of excess wax where 3 weeks conservative measures (e.g. wax softening with olive oil) have failed and where the excess wax is impairing hearing or the wax needs removing prior to the fitting of a hearing aid. NHS Stockport does NOT commission ear irrigation where the sole indication is in preparation for an aircraft flight.


Statement No. 76

Tonsillectomy for recurrent sore throat


Based on SIGN guidelines 117: Management of sore throat and indications for tonsillectomy. Watchful waiting is more appropriate than tonsillectomy for children with mild sore throats. Tonsillectomy is recommended for recurrent severe sore throat in adults. The following are recommended as indications for consideration of tonsillectomy for recurrent sore throat in both children and adults: sore throats are due to tonsillitis; the episodes of sore throat are disabling and prevent normal functioning; seven or more well documented, clinically significant, adequately treated sore throats in the preceding year; or five or more such episodes in each of the preceding two years; or three or more such episodes in each of the preceding three years.


Statement No. 79


Prior approval

form available


Plastic Surgery Not supported N/A

Plastic Surgery Breast reduction Not supported N/A



Plastic Surgery Hirsutism Not supported N/A

Plastic Surgery Not supported N/A Sep-10

Donor Oocytes Not supported N/A Donor oocytes are not commissioned Nov-10

Breast enlargement (Augmentation mammoplasty)

Whilst there is evidence of the clinical effectiveness of augmentation mammoplasty surgery this treatment is considered LOW PRIORITY and hence not commissioned.


Statement No. 4a

Jun-10 whether this policy discriminated against transgender individuals was discussed and it was agreed that it is not discriminatory

Whilst there is evidence of the clinical effectiveness of reduction mammoplasty surgery this treatment is considered LOW PRIORITY and hence not commissioned


Statement No. 4j


Surgery for gynaecomastia

Whilst there is evidence of the clinical effectiveness of surgery for gynaecomastia this treatment is considered LOW PRIORITY and hence not commissioned


Statement No. 4k


Surgery for unequal breast size

Whilst there is evidence of the clinical effectiveness of surgery for unequal breast size this treatment is considered LOW PRIORITY and hence not commissioned


Statement No. 4r

Whilst there is evidence of the clinical effectiveness of laser treatment and electrolysis for hirsutism these treatments are considered LOW PRIORITY and hence not commissioned.


Statement No. 4m


Pinnaplasty / otoplasty (Correction of

prominent ears)

Whilst there is evidence of the clinical effectiveness of pinnaplasty and otoplasty these treatments are considered LOW PRIORITY and hence not commissioned


Statement No. 4g



Statenment No. 82


Prior approval

form available


Not supported N/A

No Sep-10

Not supported N/A Sep-10


Cryopreservation of oocytes

Cryopreservation of oocytes is not commissioned by NHS Stockport as the Human Fertilisation and Embryology Authority (HFEA) still considers the technique to be experimental


Statement No. 84

01/11/2010 whether this policy discrimated against females as cryopreservation of sprem is a standard service was discussed and it was agreed that this was not discriminatory as the evidence base for sprem cryopreservation is well developed whereas oocyte cryopreservation is still experimental


Continuous passive motion therapy for rehabilitation after limb-preserving

surgery for osteosarcoma


NHS Stockport commissions the rental of continuous passive motion (CPM) machines for rehabilitation after limb-preserving surgery for osteosarcoma


Statement No. 85


Custom-made prosthetic limbs

NHS Stockport will only fund prosthetic limbs that are provided as standard by the NHS.


Statement No. 185


Prior approval

form available


Urology Erectile dysfunction N/A Sep-10

Neurology Bobath therapy Not supported N/A Sep-10

Urology Not supported N/A Sep-10

Group approval

No more than four treatments (not tablets) per four weeks are prescribable. Tadalafil Once Daily ® may not be prescribed. Drug treatments for erectile dysfunction should only be prescribed by General Practitioners for patients who:have a chronic disease associated with erectile dysfunction e.g. diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, spina bifida and spinal cord injury; and / orare receiving dialysis for renal failure; and / orhave had radical pelvic surgery, prostatectomy or kidney transplant; orwere previously receiving Caverject®, Erecnos®, MUSE®, Viagra®, or Viridal® for erectile dysfunction at the expense of the NHS on the 14th September 1998.Erectile dysfunction may be a side-effect of some drug treatments for chronic conditions where possible the drug should be changed to one which has less effect on erectile function. Drug treatments for erectile dysfunction may be prescribed where a drug switich is not possible and where counteracting the erectile dysfunction side-effect will improve compliance e.g. of a regime of antipsychotics.This also applies to vacuum pumps and constrictor rings for the treatment of erectile dysfunction. Penile prosthesis will be funded: as part of reconstructive treatment following surgery of the treatment of malignant or other diseases as part of reconstructive surgery following trauma and all non-surgical methods of treatment must previously have been exhausted. Penile Prosthesis will not be funded for cosmetic reasons. Patients with erectile dysfunction may make use of any NHS psychological and psychosexual counselling services that are available within the portfolio of service agreements.


Statement No 33

NHS Stockport does not commission services at The Bobath Centre for either new patients or patients that have previously been assessed and treated at the Centre.The service has not been commissioned for new patients for a number of years as there is lack of evidence of the superiority of the Bobath Centre over local services.


Statement No. 19

ESWT (Extracorporeal Shockwave Therapy) for Peyronie’s disease

This treatment is not commissioned owing to inadequate evidence of efficacy.


Statement No. 50


Prior approval

form available


Psychiatry Winston's Wish Not supported N/A Sep-10

Audiology Hearing Link Not supported N/A Sep-10

Neurology Neurophysiotherapy No Sep-10

No Nov-10

No Nov-10

Surgery for bunion No Nov-10

Endocrinology Not supported N/A Nov-10

Not supported N/A Nov-10

Winston's Wish is a charitable organisation providing residential courses for children suffering bereavement after the death of a parent.This service is not commissioned as local services are available.


Statement No. 63.

Hearing Concern Link is an organisation that provides an intensive psychosocial rehabilitation course for deafened adults.NHS Stockport does not commission this service as there is a local service and the level of evidence provided by Hearing Link is low.


Statement No. 64


NHS Stockport does not commission maintenance neurophysiotherapy except for children under the age of 19 with cerebral palsy.Only short courses of neurophysiotherapy (8 sessions) with well defined treatment goals will be commissioned for new patients.Only very short courses (4 sessions) with well defined treatment goals will be commissioned for previously treated patients experiencing a relapse that has had a significant effect on mobility.


Statement No. 86


Surgery for Dupuytren's contracture

Prior approval - OTS

Surgery will not be funded unless the patient has at least one of the following: 1) metacarpophalageal joint contracture of 30 degrees or more 2) Any degree of proximal interphalangeal joint contracture.


Statement No. 26


Surgery for trigger finger


Surgery will not be funded unless the patient has at least one of the following: persistent triggering 12 months after a single steroid injection; recurrent triggering or has a fixed deformity that cannot be corrected with conservative measures


Statement No. 27



Surgery will not be funded for the removal of bunions unless BOTH of the following criteria are met: 1) Confirmed diagnosis of hallux valgus associated with at least ONE of the following signs/symptoms attributable to a hallux valgus deformity: a) difficulty walking b) significant and persistent pain at the first metatarsal joint c) ulceration of the first metatarsal joint 2) signs/symptoms are unresponsive to at least six months of conservative treatment, including ALL of the following: a) padding b) analgesics or anti-inflammatory drugs c) appropriate footwear


Statement No. 29

Insulin pump therapy combined with

continuous blood glucose monitoring for the treatment of type 1

diabetes

NHS Stockport does not commission insulin pump therapy combined with continuous blood glucose monitoring for the treatment of type 1 diabetes owing to insufficient evidence of effectiveness over current treatment with insulin pump therapy combined with standard blood glucose monitoring


Statement No. 100

Pain management

Motion sensing neurostimulation for

chronic pain

NHS Stockport does not commission motion sensing neurostimulation for chronic pain owing to insufficient evidence of effectiveness compared with current neurostimulation devices.


Statement No. 99


Prior approval

form available


Not supported N/A Nov-10

N/A

Cardiology Not supported N/A

Cardiology Not supported N/A

Not supported N/A

General practice N/A

General Surgery Not supported N/A

Vascular Surgery

Angioplasty for chronic cerebrospinal venous

insufficiency in multiple sclerosis

NHS Stockport does not commission angioplasty for chronic cerebrospinal venous insufficiency in multiple sclerosis owing to insufficient evidence of effectiveness.


Statement No. 98

NICE TA continuation of treatment clause

Position statement

The standard statement in NICE Technology Appraisals People who are currently receiving the drug for the treatment of the condition and whose circumstances do not meet the criteria set out in this Technology Appraisal should have the option to continue treatment until they and their clinicians consider it appropriate to stop will not be applicable to patients coming off clinical trials unless the funding for these patients has been explicitly authorised by the commissioners in advance of commencement of the trials.


Statement No. 108

Percutaneous mitral valve repair for mitral

regurgitation

NHS Stockport does not commission percutaneous mitral valve repair for the treatment of mitral regurgitation owing to inadequate evidence of clinical effectiveness


Statement No. 111

Transcatheter Aortic Valve Implantation

(TAVI)

In line with the current recommendation from the North West Specialist Commissioning Team (NWSCT), NHS Stockport does not commission Transcatheter Aortic Valve Implantation (TAVI). Whilst there is evidence that TAVI is clinically effective a recent business case to NWSCT was rejected and the procedure was not prioritised for new investment monies. However, NWSCT did agree that if the procedure could be provided within the provider services’ existing resources it would be commissioned.


Statement No. 106

Gastroenterology

Gastroelectrical stimulation for gastroparesis

NHS Stockport does not commission gastroelectrical stimulation for gastroparesis owing to insufficient high quality evidence of effectiveness


Statement No. 103

Gluten free foods for gluten enteropathy

Group approval

NHS supply of gluten free foods should only be for patients with established gluten enteropathy. Only the following gluten free foods may be prescribed: bread – brown or white, sliced or unsliced but NOT fresh; bread mix; flour mix; part baked rolls, pasta


Statement No. 91

Transoral incisionless fundoplication for the treatment of gastro-oesophageal reflux disease (GORD)

NHS Stockport does not commission transoral incisionless fundoplication for the treatment of gastro-oesophageal reflux disease (GORD) owing to insufficient good quality evidence of effectiveness


Statement No. 104


Prior approval

form available


No

Surgery for ganglion No

Bunionectomy No

N/A

No

Baby Milk N/a


Surgery for carpal tunnel syndrome


In line with the recommendation from the Greater Manchester Effective Use of Resources Group. NHS Stockport commissions surgery for carpal tunnel syndrome, following prior approval, if the patient has at least one of the following: Mild to moderate symptoms that have not responded to at least 4 months of conservative measure. In pregnant women carpal tunnel syndrome often resolves and for those women with mild to moderate symptoms to be eligible for surgery they must have not responded to at least 4 months of conservative measures post partum; or Severe symptoms including neurological deficit such as sensory loss or weakness that will not be resolved by conservative measures


Statement No. 25



Surgery will not be funded in the following circumstances: 1) The ganglion is at the wrist; 2) The ganglion is on the top of the foot; 3) For seed ganglion at the base of the digits unless they are painful; 4) For mucoid cysts at the DIP joints unless they are disturbing the nail or have a tendency to discharge


Statement No. 28



In line with the recommendation from the Greater Manchester Effective Use of Resources Group NHS Stockport commissions bunion surgery, following prior approval, in adults that have a confirmed diagnosis of hallux valgus deformity that meet both the following criteria: Conservative treatment to manage symptoms that includes padding, appropriate footwear and analgesics or anti-inflammatory drugs has been tried for six months; and the deformity is causing either significant and persistent pain, or an obvious difficulty in walking or recurrent ulcers or recurrent infections


Statement No. 29


Insertion and Removal of Inter Uterine

Contraceptive Device

Group approval

As a stand-alone procedure IUCD insertions/ changes and removals for contraception and dysfunctional menstrual bleeding should be done out of hospital by a GP or the tier 2 service. A patient may be referred to secondary care if insertion/ removal is difficult. Insertion / change of an IUCD at the time of another procedure e.g. hysteroscopy or as part of heavy menstrual bleeding management in secondary care, is permitted in secondary care.


Statement No. 186


Ultrasound to promote bone fracture healing


NHS Stockport does not commission ultrasound to promote bone fracture healing. In cases of delayed union where the alternative intervention is unsuitable or has been unsuccessful ultrasound will be considered on an individual case-by-case basis.


Statement No. 115

General Practice

Position statement

Baby milk should not be supplied in the NHS for lactose intolerance.Baby Milk should only be supplied on the NHS for the following conditions: Cows milk protein intolerance; extreme sensitivity to cows milk allergen; multiple food allergy; proven food allergy; faltering growth as evidenced on a growth chart; extreme prematurity


Statement no 113


Prior approval

form available


Dental Endosseous Implants No

Neurology Not supported N/A

TMJ replacement No

Psychiatry Not supported No



NHS Stockport commissions dental implants in the following circumstances: As part of reconstructive treatment following surgery to the mouth and surrounding tissues for the treatment of malignant or other disease; or As part of oral and facial reconstructive treatment following severe facial trauma (two or more teeth); or For rehabilitation of patients with congenital defects, for example cleft palate, or multiple congenitally missing teeth (oligodontia); or Where there are severe eating or speaking disorders when wearing a conventional dental prosthesis.


Statement no 121


Occipital nerve stimulation for

headache

NHS Stockport does not commission occipital nerve stimulation for severe, chronic headache disorders owing to inadequate evidence of effectiveness.


Statement no 123


Maxillofacial surgery


NHS Stockport only commissions unilateral or bilateral temporomandibular joint replacement in extreme cases with high pain scores and very limited mouth opening, where the patient is aware of the inadequate evidence of safety and long-term efficacy.


Statement no 124


Gender realignment - breast augmentation

NHS Stockport considers breast augmentation as part of gender realignment as low priority and hence does not commission


Statement no 125

Gender realignment - breast removal

NHS Stockport considers breast removal as part of gender realignment as low priority and hence does not commission


Statement no 125

Mar 2012 - This would apply to M2F treatment and is similar to the gynaecomastia policy for males. The Group felt that it could potentially be discriminatory for M2F. However the PCT was not treating this group any different to males with gynaecomastia or to females seeking breast reduction. Exceptional case requests can be submitted via The Individual Funding Route.


Prior approval

form available


Psychiatry Not supported NoGender realignment - hair removal

NHS Stockport considers hair removal as part of gender realignment as low priority and hence does not commission


Statement no 125

Mar 2012 - This would apply to M2F treatment and the Group acknowledged that there is the potential to treat this group differently to a genetic male. Hair removal for genetic females is not routinely commissioned and therefore the group felt that M2F requests should be considered via the Individual Funding Route and photographs submitted to determine severity as with genetic females


Prior approval

form available




Gender realignment - speech therapy

NHS Stockport considers speech therapy as part of gender realignment as low priority and hence does not commission


Statement no 125

Mar 2012 - This would apply to both M2F and F2M. This would not be commissioned for genetic males or females. Therefore it was felt that this policy was not discriminatory and that the policy should apply to all people and not just those undergoing gender realignment surgery. The Group advised that for patients wanting this treatment then an exceptional case request will be considered via The Individual Funding Route if normal gender realignment treatment had failed. LPS 165 has since been written to address this issue

Gender realignment - thyroid chrondroplasty

NHS Stockport considers thyroid chrondroplasty as part of gender realignment as low priority and hence does not commission


Statement no 125

Mar 2012 - This would apply to M2F and would be considered to be cosmetic. Therefore The Group felt that this policy was not discriminatory as this would not be considered for anyone.


Prior approval

form available


Psychiatry No

Podiatry Not supported N/A

Facet Joint Injections

Yes

AMH testing Not supported No

Gender realignment - hysterectomy


NHS Stockport does commission hysterectomy in female-to-males owing to the risk of endometrial cancer from the hormone supplementation.


Statement no 125

Mar 2012 - This would apply to F2M and would be considered to the increased risks of cancer caused by the hormone treatments given to this group of patients. This group of patients fall in to a subset of patients with a clinical risk and as this is offered to genetic females then it was thought that this policy wasn’t discriminatory

Acupuncture for diabetic neuropathy

NHS Stockport does not commission acupuncture for diabetic neuropathy owing to inadequate good quality evidence of effectiveness


Statement no 150


Pain management

NHS Stockport does not commission therapeutic facet joint injections. A single diagnostic facet joint injection prior to radiofrequency lesioning is commissioned


Statement No. 107


Pain management

Radiofrequency lesioning


NHS Stockport commissions radiofrequency denervation of facet joints when the following criteria are met: the patient is aged over 18 years; AND the condition has failed to respond to 12 months of non-invasive therapy such as medication and physiotherapy; AND the patient experienced an 80% reduction in pain following a diagnostic facet joint injection with local anaesthetic; AND where the patient has received a previous radiofrequency denervation at the same location they received benefit that lasted as least six months; AND the radiofrequency denervation is provided as part of a comprehensive pain management plan


Statement No. 152


General Practice

NHS Stockport does not commission AMH testing to check fertility. NHS Stockport does not commission AMH testing for patients paying for private IVF cycles. NHS Stockport only commissions AMH testing where required as part of the NHS IVF pathway.


Statement No. 153



Prior approval

form available


General Surgery Bariatric surgery No

Cardiology No


NHS Stockport commissions bariatric surgery for patients with a BMI >50 or BMI between 45 and 49.9 with a serious obesity related co-morbidity (see appendix A) at first presentation who have completed an intensive weight management course provided by NHS Stockport’s Specialist Weight Management Team. Successful completion of the course is defined as: a minimum of 80% attendance; completion of a weekly food diary; weight loss or weight maintenance during the course and for the 6 months following completion of the course; and evidence of behaviour and lifestyle change during the course and for the 6 months following completion of the course e.g. weight loss and increased exercise levels. The decision as to whether a patient meets these criteria will be made by the Weight Loss Surgery Panel which reports to the Individual Funding Panel. Following a referral from the Weight Loss Surgery Panel to the Bariatric Surgery service the decision to proceed with surgery, the type of surgery and the patient’s fitness for surgery will be made by the surgeon after discussion with the patient.


Statement no 74


Fenestrated AAA stents


NHS Stockport commissions fenestrated abdominal aortic aneurysm stents where the all the following criteria are met: the patient has an expected >2 year life expectancy; and the patient has an orientated mental state; and the patient has an independent quality of life; and the patient does not require dialysis; and the patient has 2 or more abnormal parameters on cardiopulmonary exercise testing which indicates a moderate or high risk of mortality with open surgery; and the diameter of the AAA is >6 cm (equating to approximately 10% per annum rupture risk); and there is <10mm straight infrarenal neck, or <15mm angulated / conical neck making standard EVAR unsafe; and the patient has suitable ilio-femoral access i.e. suitable for 21 F sheath access or iliac conduit and <60º iliac angulation; and the AAA neck angulation and visceral artery suitability are within the device manufacturer’s instruction for use criteria; and the patient assessment and counselling is consultant led; and the case has been discussed in detail by the multidisciplinary team and with the device manufacture specialist representative; and the cases will be subject to departmental audit; and the case will be reported to Vascular Governance North West, National Vascular Database and British Society of Endovascular Therapy endorsed Globalstar registry; and the patient will be followed up long-term and the follow up will include CT imaging that will be reviewed by a multidisciplinary team.


Statement no 110



Prior approval

form available


Paediatrics No

Not supported N/A

Dental Not supported N/A

Not supported N/A

Assisted conception No

Ketogenic diet for difficult-to-control

epilepsy


NHS Stockport commissions a ketogenic diet for difficult-to-control epilepsy, in children, on an individual patient basis


Statement no 157



Height reduction surgery

NHS Stockport does not commission height reduction surgery as it is considered a cosmetic procedure and hence of low priority


Statement no 155


Removal of mercury amalgam dental

fillings for the treatment of chronic

fatigue syndrome (CFS) or myalgic encephalomyelitis

(ME)

NHS Stockport does not commission the removal of mercury amalgam dental fillings for the treatment of chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) owing to a lack of evidence of benefit


Statement no 156


Pain management

Residential interdisciplinary

management for the treatment of complex

regional pain syndrome in adolescents

NHS Stockport does not commission residential interdisciplinary management for the treatment of complex regional pain syndrome in adolescents owing to a lack of evidence of its superiority over out-patient interdisciplinary pain management services


Statement no 160



Group approval

Referral for 1 cycle of IVF should only be made for couples meeting the following eligibility criteria at the time of referral. IVF will only be provided if these criteria are still met at the time of treatment commencement: Couples have not had a privately funded IVF cycle. Couples have failed to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology. Women are aged between 23 and 39 years old at the time of treatment. Women’s BMI is between 19-29. Both partners are non-smokers. Both partners can give assurance that alcohol intake is within Department of Health guidelines and they are not using recreational drugs. Childless couples are eligible. This includes new couples where only one partner has a child. Surgical sperm retrieval is commissioned where the male partner has oligospermia provided it is not as a result of a sterilisation procedure. IVF is not funded following reversal of sterilisation.


Statement no 170


Prior approval

form available


Not supported N/A

Urology Not supported N/A

Not supported N/A

Oncology No

Sperm washing N/A


Reversal of Female Sterilisation

NHS Stockport does not commission reversal of sterilisation for males or females. NHS Stockport considers reversal of sterilisation to be low priority because sterilisation is provided under the NHS on the understanding that it is an irreversible procedure. Patients are informed and written consent is sought before the operation is carried out. NHS Stockport does not commission IVF following male or female sterilization or when azoospermia or oligospermia occurs following male reversal of sterilisation


Statement no 5


Reversal of Male Sterilisation

NHS Stockport does not commission reversal of sterilisation for males or females. NHS Stockport considers reversal of sterilisation to be low priority because sterilisation is provided under the NHS on the understanding that it is an irreversible procedure. Patients are informed and written consent is sought before the operation is carried out. NHS Stockport does not commission IVF following male or female sterilization or when azoospermia or oligospermia occurs following male reversal of sterilisation


Statement no 5


Sppech and Language

Speech therapy to alter voice pitch

NHS Stockport does not commission speech therapy to alter voice pitch as this is considered a low priority.


Statement No. 165

Apr 2012 - The Group felt that this policy was not discriminatory.

PleurX peritoneal catheter drainage

system for vacuum-assisted drainage of treatment-resistant, recurrent malignant

ascites.


NHS Stockport commissions, on an individual case basis, PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites based on the evidence and recommendations made in NICE Medical Technology Guidance (MTG)9


Statement No. 166



Group approval

NHS Stockport follows the Greater Manchester Sexual Health Network (GMSHN) commissioning guidelines for access to sperm washing for HIV+ men


Statenment No. 197


Prior approval

form available


Urology Circumcision N/A

N/A

Not supported N/A

Not supported N/A

Group approval

Circumcision is considered a low priority treatment and will only be considered for a small number of therapeutic reasons: pathological phimosis where inability to retract the foreskin is due to permanent scarring of the preputial orifice; penile malignancy; severe recurrent attacks of balanoposthitis (inflammation of the glans and foreskin); recurrent febrile UTIs particularly with high grade ureteric reflux where circumcision would reduce further infections; tight symptomatic phimosis in over 16 year olds. Circumcision for religious, cultural or lifestyle reasons is not commissioned as it is low priority for NHS funding. Circumcision to reduce future risk of contracting conditions including penile cancer or sexually transmitted diseases (including HIV/AIDS) is not commissioned owing to a lack of evidence of clinical and cost effectiveness.


Statenment No. 14



Collagenase injections for Dupuytrens

contracture

Group approval

NHS Stockport commissions collagenase injections for Dupuytren’s contracture where the following criteria are met: the patient has a metacarpophalangeal joint contracture of 30 degrees or more; or any degree of proximal interphalangeal joint contracture; the patient has no more than two joints per hand affected; the patient has a palpable cord; and percutaneous needle fasciotomy is not suitable.


Statenment No. 162


General Practice

Device-guided breathing techniques (Resperate) for the

treatment of hypertension

NHS Stockport does not commission device-guided breathing techniques (Resperate®) for the treatment of hypertension owing to inadequate evidence of benefit over other relaxation techniques


Statenment No. 168


Replacement equipment

NHS Stockport does not commission replacement equipment, including but not limited to BAHAs and cochlear implant speech processors, which has been lost or damaged.


Statenment No. 169

June 2012 - The Group recognised that this policy was more likely to affect children, patients (including adults) with a learning disability and low income families. Hence clinicians could apply via the Individual Funding Route where exceptional cases would be considered, rather than a blanket rule applied to all


Prior approval

form available


Surrogacy Not supported N/A

Not supported N/A


NHS Stockport does not commission surrogacy as it is considered low priority.


Statenment No. 198

June 2012 - The Group recognised the differential impact this decision will have on women and a restricted age range, however they felt that the decision was consistent with NHS Stockport’s assisted conception policy. Furthermore, the group noted that partial NHS funding for private patients would discriminate against those patients who are unable to afford the private part of the treatment, which impacts on a number of protected characteristics in the borough, particularly ethnic minority groups who are more likely to live in the deprived areas.

Paediatrics / psychiatry

Pressure devices for autism

NHS Stockport does not commission pressure devices, such as Squease, weighted vests and Grandin’s Hug Machine, for the treatment of autism.


Statenment No. 199

June 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence suggests these devices are not effective.


Prior approval

form available


Vitamin D testing No

Not supported N/A

Ophthalmology No

Paediatrics No

Not supported N/A

General Practice


There is a lack of evidence that a ‘test and treat’ policy improves outcomes. Testing for vitamin D is not to be requested from primary care without prior approval except where the test is being undertaken immediately after a course of high dose vitamin D to check that levels have returned to normal. In symptomatic individuals with the following, a request can be made to the EUR team for testing: Rickets, osteomalacia or symptomatic hypocalcaemia; High risk patient group with suggestive symptoms such as proximal muscle weakness or musculoskeletal aches and pains. High dose vitamin D should not be initiated in primary care for patients under the care of Stockport NHS Foundation Trust. High dose vitamin D may be initiated in primary care following a recommendation from a secondary care clinician based in a hospital other than Stepping Hill.


Statenment No. 114


General Practice

Sunscreen preparations

NHS Stockport does not fund sunscreen preparations except where there is abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis.


Statenment No. 203


Cultivated limbal stem cell allograft for

regrowth of corneal epithelium


NHS Stockport commissions cultivated limbal stem cell allograft for regrowth of corneal epithelium where: both eyes are affected by disease; other techniques have failed; and vision is severely affected and likely to be significantly improved if the allograft is successful


Statenment No. 200

Jul 2012 - The Group felt that this policy was not discriminatory.

Hypnotherapy for Irritable Bowel (IBS) in

children


Hypnotherapy for the treatment of IBS in children (under 18s) is commissioned on an individual case basis for children where all alternative, conventional treatments have failed to alleviate symptoms


Statenment No. 16a

Aug 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of age, but did not discriminate as the clinical evidence suggests this intervention is less effective in adults than children


ACI for knee cartilage damage

NHS Stockport does not commission ACI, including CCI in the form of ChondroCelect, for the treatment of knee cartilage damage owing to limited evidence of additional benefit over the current standard treatment of microfracture.


Statenment No. 204



Prior approval

form available


Not supported N/A

Not supported N/A

Powerbreathe Not supported N/A

Paediatrics No

Dermatology / General Practice

Dermasilk clothing for eczema

NHS Stockport does not commission Dermasilk clothing for eczema owing to inadequate evidence of clinical effectiveness. This policy applies for both children and adults


Statenment No. 202

Sep 2012 - The Group felt that this policy was not discriminatory


therapies

Hypnotherapy for needle phobia

NHS Stockport does not commission hypnotherapy for needle phobia owing to inadequate evidence of efficacy


Statement No. 8a

Oct 2012 - The Group felt that this policy was not discriminatory

General Practice

NHS Stockport does not commission Powerbreathe for COPD owing to limited evidence of superior effectiveness compared to pulmonary rehabilitation.


Statement No. 222

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence supports this policy decision

Selective dorsal rhizotomy


NHS Stockport commissions an assessment for selective dorsal rhizotomy, at the Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust in Oswestry, when all the following criteria are met: the assessment is recommended by a consultant paediatrician; the child is aged 4-11 years; the child has bilateral lower limb spastic cerebral palsy; the child has lower limb strength against gravity; the child is ambulatory with or without assistive devices; and there is no injury to basal ganglia evident on an MRI. Children meeting the above criteria may not be suitable for a referral if any of the following are present: athetosis, dystonia, orthopaedic surgery within the last 6 months, chronic conditions such as bronchopulmonary dysplasia, refractory epilepsy, severe visual impairment, severe fixed joint deformities, severe scoliosis, hip dysplasia, a history of meningitis, a history of hydrocephalus unrelated to prematurity, a history of head trauma, a high BMI, poor motivation of child and/or family with regard to intensive rehabilitation required post-procedure. NHS Stockport commissions selective dorsal rhizotomy for those children found suitable for the procedure following an assessment.


Statement No. 154

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristics of age and disability, but did not discriminate as the clinical evidence suggests this intervention is less effective in children than adults


Prior approval

form available


Plastic Surgery Cosmetic Not supported N/A

Not supported N/A

Urology No

Treatments in this section are considered LOW PRIORITY. Cosmetic treatments are not commissioned except in the following circumstances: As part of reconstructive treatment following surgery for the treatment of malignant or other disease; As part of reconstructive treatment following trauma. In exceptional circumstances and after special consideration, Stockport PCT, may allow a cosmetic treatment to proceed. These exceptional circumstances should be primarily clinical e.g. There is a significant likelihood that the individual will gain much higher than average benefit from treatment; There would be additional benefit through avoidance of social care; The patient’s appearance is extreme and the proposed treatment is likely to be effective.


Statement No. 4



Autologous chondrocyte

implantation (ACI) for the treatment of ankle

cartilage damage

NHS Stockport does not commission autologous chondrocyte implantation (ACI) for the treatment of ankle cartilage damage owing to inadequate evidence of effectiveness.


Statement No. 220


Prosthetic testicle post-orchidectomy


NHS Stockport commissions the provision of a prosthetic testicle post-orchidectomy either at the time of the orchidectomy or at a later date.


Statement No. 219

Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of sex, but did not discriminate as it is in line with funding of breast reconstruction post mastectomy

treatment list

Documents

persistent bilateral ome

beta thalassaemia major

unprotected sexual intercourse

sickle cell crisis

related macular degeneration

chronic lymphocytic leukaemia

acute myeloid leukaemia

acute lymphoblastic leukaemia