Choosing wisely

Choosing wisely 2018-03-16T10:46:48+00:00

NHS Richmond Clinical Commissioning Group (CCG) asked local people to participate in the ongoing discussions about health spending in the borough. The survey closed on Friday 3 February and we received 398 responses.

In December 2016, Richmond CCG shared a paper and survey (Choosing Wisely for Richmond), with local people asking for their views on proposals:

  • to change the access criteria to IVF (In Vitro Fertilisation) so that cycles are offered  ‘on an exception only’ basis.
  • to review prescribing of gluten free foods, vitamin D, baby milk and self-care medications which are now widely available at a reasonably low cost, both online and in local shops. We are asking for feedback on the extent to which the local NHS should prescribe items that can bought more cheaply and directly by the patient.​
  • for GPs in Richmond to help encourage patients who smoke or have excess weight to make some lifestyle changes before they have surgery.

Read about our proposed changes by reading the choosing wisely document​. Please note the survey is now closed.​

Read an overview of the responses received by reading the Choosing Wisely engagement report​​

During this stage of engagement the CCG made the following decisions at its governing body meeting in public in January 2017 in relation to two of the proposals:

  • To undertake an 8 week consultation on specific proposals for IVF and ICSI services.  This consultation ran from 7 February to 4 April 2017.
  • To have the proposal to support patients to be surgery ready as guidance only

This option would mean women who meet the criteria as outlined (below) will continue to be offered one fresh cycle and one frozen cycle of IVF on the NHS:

  • women 39 years of age or below; and
  • neither partner must have any living children from this or previous relationships (including adopted children) and
  • who are in a current long term relationship (at least one year)

Access to IVF would be limited to patients who meet the criteria in option 1 and who can demonstrate exceptional clinical circumstances; these might include infertility following cancer treatment, or prevention of the transmission of chronic viral infections, such as HIV (among others). As part of the consultation people were asked whether there are other specific circumstances that we should consider.

Richmond CCG received a total of 276 written responses, and a summary of the consultation feedback has been published on the CCG’s website.

As part of the consultation process respondents suggested that the CCG consider other options, or further restrict the current eligibility criteria in order to maintain a level of IVF services in the borough. This option was also supported in discussions with the Assisted Conception Unit at Kingston Hospital who suggested that access should be based on clinical evidence associated with successful outcomes of fertility.

A decision was taken at Richmond CCG’s public governing body meeting to support a third option by adding the following eligibility criteria to the current policy:

  • No previous self-funded cycles of IVF
  • Reduce the IVF age to <39 (the evidence shows that successful outcomes reduce with age)
  • Reduce access to people with an AMH level of <5.4pmol/l (this is an indicator of fertility and below this level there is less likelihood of success).

The CCG’s policy was updated with a start date of 1 August 2017.

Outcome of the IVF (In Vitro Fertilisation) and specialised fertility services consultation

A decision was taken at Richmond CCG’s public governing body meeting on 18 July to change the access criteria to in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI). These changes have been informed by feedback received during the public engagement exercise ‘Choosing Wisely for Richmond’ and a public consultation.

The ‘Choosing Wisely’ engagement exercise showed that 51% of respondents strongly agreed or agreed and 37% disagreed or strongly disagreed that the local NHS should reduce the number of IVF cycles offered from one to on an exception only basis.

The CCG recognised that this is a sensitive issue and a difficult decision to make. Therefore at the January 2017 meeting of the governing body the decision was taken to hold a public consultation on the option to remove funding for IVF in all but exceptional cases.

The formal public consultation which ran from 4 February to 4 April 2017 presented two options for people to comment on:

​Outcome of the review of prescribing: gluten free foods, vitamin D, baby milk and self-care medications

A decision was taken at Richmond CCG’s governing body meeting in public, that the CCG no longer supports the routine NHS prescribing of the following products:

  • Prescriptions for gluten free food
  • Prescriptions for vitamin D maintenance
  • Prescriptions for medicines which are available over the counter

These decisions were taken following an engagement exercise (Choosing Wisely for Richmond) which took place between 22 December 2016 and 3 February 2017. You can see a detailed report of the findings of the engagement exercise here.

Prescribing changes

Richmond CCG has produced pati​ent information leaflets and position statements that relate to the prescribing changes.​

Prescriptions for baby milk

As part of the Choosing Wisely engagement, Richmond CCG also looked at the option of reducing prescriptions for baby milks and specialist infant formula. However, during the engagement exercise we received feedback from a number of sources about the complex nature of milk allergy. As a result, for now we will focus on developing improved guidelines and education for GPs and other healthcare professionals to advise when prescribing is suitable or not. These resources will be developed with dieticians, other healthcare professionals and stakeholders including Allergy UK and will be supported with patient information.

The case for change

Richmond CCG has a legal responsibility to ensure that it lives within its means in future and everyone in Richmond has equal access to operations; and that only treatments which offer value to our population are commissioned. Read more about our​ future plans​ here​.

​Further information​

Contact: ccginvolve@richmond.gov.uk or call 020 8734 3001