Commissioning Policy Development

Information to help explain the BNSSG Commissioning Policy Development Process and how the ICB decides what to fund.

This is the agreed policy review process which is carried out at the earliest of three years, NICE updates, or amendments to the policy for other reasons as per the terms of reference (TOR).

Commissioning Policy Development Process

Commissioning Policy Review Group (CPRG) Terms of Reference

Abbott FreeStyle Libre® Flash Glucose Monitoring System

Information about Abbott FreeStyle Libre® Flash Glucose Monitoring System on the CCG Exceptional Funding Requests Directory.
Related keywords:
FreeStyle Monitor
Who can apply:
Consultant
Referral routes:
Criteria Based Access

Abdominal Loose Skin Removal

Request for a referral for abdominoplasty and removal of loose skin
Related keywords:
Tummy tuck, excess skin, excess fat, high BMI, Fleur-de-Lys abdominoplasty, mini abdominoplasty, apronectomy
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Acupuncture

Request for a referral for Acupuncture treatment.
Related keywords:
Chinese medicine, needles, complementary medicine, alternative medicine
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Adenoidectomy

Request for a referral for assessment for an Adenoidectomy.
Related keywords:
Adenoids, tonsils, lymphoid (glandular) tissue, Waldeyer’s ring, ENT
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Anal Skin Tag Removal

Request for a referral for removal of anal skin tags
Related keywords:
Rectal growth, skin lesion
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Benign Skin Lesions

Request for a referral for removal of benign skin lesions
Related keywords:
Warts and plantar warts, seborrhoeic keratoses (benign skin growths, basal cell papillomas, warts), spider naevi, thread veins, benign pigmented naevi (moles), dermatofibromas (skin growths), skin tags, sebaceous cysts (pilar & epidermoid cysts), lipomata (fat deposits underneath the skin), xanthelasmas (cholesterol deposits underneath the skin) and port wine stains
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Blepharoplasty

Request for a referral for removal of excess skin (dermatochalasis) from the eyelids (blepharoplasty)
Related keywords:
Drooping eye lid, puffy bags below the eyes, excess tissue above the upper eyelids (dermatochalasis)
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Breast Reconstruction Post-Cancer

Request for a referral for Breast Reconstruction post-Cancer
Related keywords:
Breast surgery, post-cancer, contralateral breast surgery
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Breast Surgery (for Females)

This merged policy includes all surgeries to alter or improve the appearance of female breasts, except Breast Reconstruction Post Cancer, and supersedes previous breast policies.
Related keywords:
Breast Implant Surgery, Augmentation, Asymmetry, Reduction, Mastopexy, Uplift, correction of inverted nipples
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Breast Surgery (for Males)

Funding request for a referral for breast surgery for male patients.
Related keywords:
Swelling breast, extra breast tissue, prominent breasts, breast reduction, gynaecomastia, breast asymmetry, Amastia
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Carpal Tunnel Syndrome Surgery

Request for a referral for removal of carpal tunnel
Related keywords:
Muscle wasting, nerves of the hand, carpal tunnel release
Who can apply:
General Practitioner, Musculoskeletal Assessment and Treatment Service, Clinical Assessment and Triage Service
Referral routes:
Criteria Based Access

Cataract Surgery

Request for referral for surgical treatment of cataracts.
Related keywords:
Visual acuity, cataracts, eye sight, imbalance, anisometropia, anisekonia
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Chalazia Removal

Request for a referral for removal of chalazia
Related keywords:
Meibomian cyst, meibomian gland duct
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Chiropractic Assessment and Treatment

Request for a referral for chiropraxis
Related keywords:
Manipulation of the spine, musculoskeletal system
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Closure of Patent Foramen Ovale for Migraine

Request for a referral for closure of patent foramen ovale for migraine
Related keywords:
OVALE, migraine, foramen
Who can apply:
Consultant
Referral routes:
Exceptional Funding Request Panel

Correction of Chest Wall Deformity for Cosmetic Purposes

Request for a referral with regards to the Correction of Chest Wall Deformity for Cosmetic Purposes
Related keywords:
Chest wall deformity, pectus excavatum, funnel chest, pectus carinatum, poland syndrome, pigeon chest, pectus arcuatum and sternum
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Cosmetic Contact Lenses

Funding request for Cosmetic Contact Lenses
Related keywords:
contact lenses, plano cosmetic, disfigured eyes, misaligned eyeball, exotropia, amblyopia, inoperable cataracts, coats disease, heterochromia
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Cosmetic Surgery or Treatment

Request for cosmetic surgery/treatment
Related keywords:
Post-trauma injury, Umbilicoplasty, Buttock Enhancement, Hair Transplants, Chin, Cheek and/or Lip enhancement, Cosmetic Dentistry, Dermal Fillers (including Collagen fat Injection), Scar revision (including Keloid Scarring), Shave Rhynophyma, Dermabrasion or Chemical Peel of the skin
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Dilatation and Curettage in Women with Menorrhagia

Request for a referral for diagnostic dilatation and curettage (D&C) in women <40 yrs with menorrhagia
Related keywords:
Hypermenorraghia, menstruation, menorrhagia, menstrual period
Who can apply:
Consultant
Referral routes:
Exceptional Funding Request Panel

Divarication of Recti

Request for a referral for treatment of Divarication of Recti.
Related keywords:
Tummy muscles, muscle weakness, divarication
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Dupuytren’s Contracture Release in Adults

Request for a referral for Dupuytren’s Contracture Release
Related keywords:
Flexion deformity, metacapophalanageal joint and proximal interphalangeal joint
Who can apply:
General Practitioner, Musculoskeletal Assessment and Treatment Service, Clinical Assessment and Triage Service, Musculoskeletal
Referral routes:
Criteria Based Access

Ectropion and Entropion Surgery

Funding Request for Ectropion and Entropion Surgery
Related keywords:
ectropion, entropion, eyelashes, vision loss
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Epididymal Cysts

Request for a referral for removal of epididymal cysts
Related keywords:
Cysts, testicular lump, epididymal and testes
Who can apply:
General Practitioner
Referral routes:
Prior Approval

EXOGEN Ultrasound Bone Healing System

Request for a referral for Exogen Ultrasound Bone Healing System Requests in Bristol.
Related keywords:
Exogen Ultrasound Bone Healing System, bone fracture, long bone, ultrasound waves, bone healing
Who can apply:
Consultant
Referral routes:
Prior Approval

External Ear Surgery

External Ear surgery
Related keywords:
Ear lobe, cartilage, cauliflower ear, cleft ear lobes
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Facial Surgery and Treatment

Request for Facial Surgery and Treatment (facelift)
Related keywords:
Brow lift, Cosmetic facial injections, Facelift or Rhytidectomy, Laser Surgery for sun damage, ageing and wrinkles, Lip Enhancement including lipotransfer, Reshaping of the Check including implants and lipotransfer, Reshaping of the Chin including Implants and lipotransfer
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Female Genitalia Surgery

Requests for Female Genitalia Surgery. Please note the CCG will not approve funding for patients below 18 years of age and all requests for funding, where appropriate, will be shared with the designated CCG Safeguarding Lead.
Related keywords:
Labiaplasty, Trauma, Vaginoplasty, Rejuvenation, Vaginal tone / canal
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Female Sterilisation

Funding request for Female Sterilisation
Related keywords:
Sterilisation, female contraception, tubal occlusion
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval

Fertility Assessment and Treatment

Request for funding for a fertility assessment (CBA) or treatment (PA)
Related keywords:
IVF, ICIS, IUI, DONOR, DIUI, embryo transfer, sperm freezing, embryo hatching, cryopreservation
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval, Criteria Based Access

Forefoot Surgery in Secondary Care

Request for a referral for Surgical Foot Treatment: Including Bunions, Toe Deformity, Morton’s Neuroma and Plantar Fasciitis.
Related keywords:
Bunions, Toe Deformity, Morton’s Neuroma, Plantar Fasciitis, foot treatment, feet, Hallux Rigidus, Hammer Toe, Mallet toe, Claw Toe
Who can apply:
General Practitioner, Consultant, Musculoskeletal Assessment and Treatment Service
Referral routes:
Criteria Based Access

Gallbladder Removal in Adult Patients - Over 18 years

Request for a Referral for Removal of Gallbladder (Laparoscopic Cholecystectomy) in Adults
Related keywords:
Gallstones, gallbladder, cholecystitis, jaundice, biliary calculi and cirrhosis
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Ganglion Referral and Removal

Request for a referral for removal of ganglion or ganglia
Related keywords:
Ganglion, ganglia
Who can apply:
General Practitioner, Musculoskeletal Assessment and Treatment Service, Clinical Assessment and Triage Service, Musculoskeletal
Referral routes:
Exceptional Funding Request Panel

Haemorrhoids – Surgical Treatment

Request for a referral for haemorrhoidectomy
Related keywords:
Piles, rectal bleeding, haemorrhoidectomy
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Hair Removal (including Electrolysis and Laser Therapy)

Request for a referral for hair removal (including electrolysis & laser therapy)
Related keywords:
Hirsutism, hair removal, electrolysis, laser therapy, hair growth
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Hernia Repair in Adults

Request for referral for hernia repair in adults
Related keywords:
incarceration, risk of strangulation, inguino-scrotal hernia
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Homeopathy

Request for a referral for homeopathy
Related keywords:
alternative medicine
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Hydroceles - Surgical Removal - under 16 years of age

Request for funding for a referral for surgical treatment of hydroceles in males under 16 years
Related keywords:
hydroceles surgical removal
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval

Hydroceles in Patients over 16 years of Age

Request for funding for hydroceles in patients over 16 years of age
Related keywords:
Hydrocele, fluid inside scrotum, testicles
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval

Hyperhidrosis Treatment

Request for a referral for (treatment of) hyperhidrosis
Related keywords:
Sweating, hot flushes, perspiration, hyperhidrosis
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Hysterectomy for Menorrhagia

Request for a referral for hysterectomy for menorrhagia
Related keywords:
Womb removal, hysterectomy, endometrial ablation, myomectomy, menstrual bleeding
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Ingrown Toenail Treatment in Secondary Care

Request for funding for treatment of ingrown toenails in secondary care.
Related keywords:
Toenail avulsion, toenail removal, foot treatment
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Knee Arthroscopy and Irrigation

Request for a referral for knee arthroscopy and irrigation
Related keywords:
Intra- articular
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Laryngeal or Voice Box Surgery

Request for laryngeal surgery (voice box)
Related keywords:
Voice box, Laryngeal, Dysphonia
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Laser Eye Surgery for Refractive Error

Laser Eye Surgery for Refractive Error
Related keywords:
Short sighted, Myopia
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Laser Hair Removal for Pilonidal Disease

Funding requests for a referral for Laser Hair Removal for Pilonidal Disease
Related keywords:
hair removal, laser, pilonidal abscess, pilonidal sinus, sacrococcygeal fistula
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Liposuction

Request for liposuction to reduce fat pockets & deposits
Related keywords:
Lipo, Fat pockets
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Management of Low Back Pain and Sciatica in over 16s

Request for Facet Joint Injections, Medial Branch Blocks, Epidural Injections and Nerve Root Blocks in Secondary Care
Related keywords:
spinal injections, low back pain, sciatica, facet joint injections, medial branch block, epidural
Who can apply:
General Practitioner, Consultant, Musculoskeletal
Referral routes:
Criteria Based Access, Exceptional Funding Request Panel

Management of Patients Moving In/Out of BNSSG ICB

Related keywords:
Relocation, transfer
Who can apply:
General Practitioner, Consultant, Musculoskeletal Assessment and Treatment Service, Clinical Assessment and Triage Service, Musculoskeletal
Referral routes:
Exceptional Funding Request Panel

Microsuction for Ear Wax, Discharge or Debris Removal in Secondary Care

Request for referral to remove wax, discharge or debris from the ear by microsuction in secondary care
Related keywords:
Ear wax, ear blockage, tinnitus, vertigo, earache, wax, ear canal, keratin, otalgia, otitis externa
Who can apply:
General Practitioner
Referral routes:
Prior Approval, Criteria Based Access

MRI Breast Screening

Request for annual MRI breast screening.
Related keywords:
TP53, BRCA1, BRCA2
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Multiple Chemical Sensitivity (MCS) and Clinical Ecology / Environmental Medicine

Request for referral for treatment of multiple chemical sensitivity (MCS) and clinical ecology / environmental medicine
Related keywords:
Enzyme Potentiated, Desensitation, EPD, Total Allergy syndrome, Idiopathic environmental, Intolerance, IEI, MCS
Who can apply:
Consultant
Referral routes:
Exceptional Funding Request Panel

Nasal Treatment - Non Cosmetic for All Ages

Request for assessment of nasal conditions and non-cosmetic treatment
Related keywords:
Nose, Nasal, Rhinoplasty, Septorhinoplasty, Septoplasty, Cleft lip, Cleft Palate, Craniofacial deformity, Bilateral, deviated septum, polyps, sinusitis, turbinates
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval

Open MRI Scanner

Request for a referral for the open MRI scanner
Related keywords:
Open MRI Scanner, claustrophobia
Who can apply:
General Practitioner, Consultant, Musculoskeletal Assessment and Treatment Service
Referral routes:
Criteria Based Access

Prophylactic Mastectomy

Request for removal of the breast or breasts (mastectomy) as a preventative measure.
Related keywords:
Elective Breast Removal, Breast surgery
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Prostatic Urethral Lift (UroLift® System)

A prostatic urethral lift (UroLift® System) procedure, will be commissioned for clinically eligible patients who would otherwise have been offered a TURP procedure.
Related keywords:
TURPS, Urolift, Lower Urinary Tract Symptoms
Who can apply:
Consultant
Referral routes:
Criteria Based Access

Raised Intraocular Pressure

Request for a referral for treatment of raised intraocular pressure.
Related keywords:
Glaucoma, Intraocular pressure
Who can apply:
General Practitioner, Consultant
Referral routes:
Criteria Based Access

Reversal of Vasectomy or Female Sterilisation

Request for reversal of vasectomy or female sterilisation.
Related keywords:
Vasectomy or female sterilisation (tubal ligation)
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Shoulder Impingement Surgery for Subacromial Pain

Requests for a referral for shoulder impingement surgery for subacromial pain.
Related keywords:
subacromial impingement, painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, thrower's shoulder
Who can apply:
General Practitioner, Consultant, Musculoskeletal
Referral routes:
Criteria Based Access

Skin Camouflage Services

Request for referral to skin camouflage services.
Related keywords:
Skin Camouflage, facial scars, birthmarks, skin conditions, facial disfigurement
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval

Snoring - Surgical Intervention for Simple Snoring

Request for referral for surgical intervention for simple snoring.
Related keywords:
Snoring, uvulopalatopharyngoplasty (UPPP), laser-assisted uvuloplatoplasty (LAUP), soft palate implants, radiofrequency ablation
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Spinal Surgical Opinion – Referral for Assessment

Request for funding for a referral for assessment and spinal surgical opinion.
Related keywords:
Nerve root involvement, Lumbar spine, Back pain, Leg pain, Spinal fusion
Who can apply:
General Practitioner, Musculoskeletal Assessment and Treatment Service, Clinical Assessment and Triage Service, Musculoskeletal
Referral routes:
Prior Approval

Strabismus or Amblyopia in Adults (Surgical Correction of)

Request for a referral for surgical correction of strabismus or amblyopia in adults.
Related keywords:
strabismus, squint, esotpropia, exotropia, hypertropia, hypotropia, diplopia, amblyopia, lazy eye
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Syndactyly - Surgical Correction of the Fingers

Request for a referral for surgical correction of syndactyly (in fingers only).
Related keywords:
Syndactyly, Webbed fingers, Zygodactyly, Synpolydactyly, Ring-small syndactyly, Haas-type polysyndactyly, syndactylized, joined digits
Who can apply:
General Practitioner, Consultant, Musculoskeletal Assessment and Treatment Service
Referral routes:
Prior Approval

Tattoo Removal

Request for a referral for tattoo removal.
Related keywords:
Tattoo, removal
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Testicular Prosthesis

Request for referral for testicular prosthesis insertion.
Related keywords:
Testis, Testicular
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Tongue-Tie Division Surgery

Request for a referral for tongue-tie division surgery.
Related keywords:
Ankyloglossia, breastfeeding, aberrant structures
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Tonsillectomy – All Ages

Request for funding for assessment for a tonsillectomy for patients of all ages.
Related keywords:
tonsils, sore throat, acute tonsillitis, quinsy, persistent significant obstructive sleep apnoea, psoriasis exacerbated by tonsillitis
Who can apply:
General Practitioner, Consultant
Referral routes:
Prior Approval, Criteria Based Access

Trigger Finger

Request for a referral for trigger finger (stenosing tenosynovitis) surgery.
Related keywords:
Flexor tendon, retinacula pulley system, flexing, triggering
Who can apply:
General Practitioner, Consultant, Musculoskeletal Assessment and Treatment Service
Referral routes:
Criteria Based Access

Uvula Removal

Request for a referral for surgical removal of the palatine uvula.
Related keywords:
Emetic Effect, Velopharyngeal insufficiency, Snoring and Sleep Apnoea, Nasal Regurgitation and Inflammation
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel

Varicose Veins Surgery

Request for a referral for assessment for varicose veins surgery.
Related keywords:
Thrombophlebitis, varicosity, ulceration
Who can apply:
General Practitioner
Referral routes:
Prior Approval

Vasectomy

Request for funding for a vasectomy.
Related keywords:
vasectomy, Sterilisation
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Vitreous Floaters

Request for referral for treatment of vitreous floaters.
Related keywords:
floaters, black dots, vitrectomy, laser vitreolysis
Who can apply:
General Practitioner
Referral routes:
Exceptional Funding Request Panel

Weight Management Service - Tier 3 and Tier 4 Service

Request for funding for a referral to the tier 3 and tier 4 weight management service.
Related keywords:
weight management, bariatric, tier 3, weight loss
Who can apply:
General Practitioner
Referral routes:
Criteria Based Access

Wigs, Hairpieces and Hair Replacement Systems

Request for a referral for wigs, hairpieces and hair replacement systems.
Related keywords:
Wigs, hairpieces, hair replacement, hair loss, alopecia
Who can apply:
General Practitioner, Consultant
Referral routes:
Exceptional Funding Request Panel