Choosing wisely

///Choosing wisely
Choosing wisely 2018-03-16T10:06:10+00:00

Choosing wisely for the population of Richmond

In September 2016 Richmond Clinical Commissioning Group's (CCG) governing body received and approved a paper "Re-commissioning and clinical threshold options report" (The September Paper).  The September Paper built on the content of the CCG's financial recovery plan (FRP), which was also presented at that governing body meeting, and set out a range of options for Richmond CCG to consider which would have the effect of making savings by making three types of changes.

In order to ensure that Richmond CCG remains within its allocated budget in future, that everyone in Richmond has equal access to operations and that only treatments which offer value to our population are commissioned, we have set out a number of clinical policies which set thresholds for some treatments and do not fund other treatments except in very limited and exceptional circumstances (e.g. many cosmetic procedures).  All CCGs should periodically review the services they commission in light of new evidence, technology change and financial environment.   Responsible disinvestment is as important as the process to make investments in new services in order to provide best possible health outcomes for the whole population.

Business as usual​

​The governing body agreed to revise the clinical policies for treatment such as:​

  • Arthroscopic knee surgery
  • Dupuytren's fasciotomy surgery
  • Bunion surgery
  • Carpal tunnel surgery
  • Asymptomatic gallstones

​​​Under consideration

​The governing body also agreed to review the thresholds for the following:

  • Circumcision
  • Tonsillectomy
  • Grommets
  • Varicose veins

The CCG is also considering two further proposals which will undergo a fuller and more formal process before we enact them.  These are the options to:

  • limit access to IVF and some specialised fertility treatments to exceptional cases only
  • apply a policy which would require all relevant patients be referred to a smoking cessation service and partake in weight management services before being referred for an operation in all but the most urgent cases​

In addition we will be compiling a list of medicines that we may no longer wish to fund which are available over the counter from pharmacies. These could include gluten free food, some vitamins and baby milk.​​

IVF consultation

In light of the responses we have already received to the survey, the CCG's governing body, agreed at its meeting on 17 January 2017, to launch an eight week public consultation on the proposed changes to IVF. The consultation exercise, will be launched in February, and will give people a further opportunity to comment in more detail on this proposed change.
At the meeting it was also agreed that there will be a pause on new referrals to IVF while the service is being reviewed. During the consultation period, GPs will continue to refer patients for fertility investigations.
However, should IVF or ICSI​ be recommended following fertility investigations, new patients will not be referred until the results of this consultation are known, and a final decision taken on the access criteria.
This will not impact on couples who are currently undergoing IVF or ICSI​ treatment.​

New materials for GPs

Also, and in light of early indications from the ongoing engagement exercise, it was agreed that new resources will now be prepared for GPs so they can give additional support to patients who are overweight or smoke, before they are referred for surgery.

Read the choosing wisely for Richmond engagement document and survey.

Full details of the proposals can be read in our governing body papers​.