NHS low priority procedures (LPPs)
In this article we will describe NHS low priority procedures (LPPs).
Local NHS funding organisations (Integrated Care Boards, known as ICBs) have an obligation to refer to national guidance to reduce the variation of care provision (also known as the ‘postcode lottery’) that exists across England.
The intention is that quality of care commissioned (i.e. bought) will be uniform, appropriate and follow the principles of good medical practice. Doctors can still use their discretion and judgement where appropriate and where it is justifiable.
ICBs refer to the NHS Evidence-Based Interventions Programme for guidance. Its aim is identify interventions of limited benefit or procedures that could potentially be harmful.
The basic principles are as follows:
- Reduce avoidable harm to patients by discussing risks and benefits
- Save valuable professional time particularly when the NHS is severely short of staff
- Help doctors maintain their professional skills by keeping up to date with the changing evidence base and best practice
- Allow for innovation
- Maximise value and avoid waste and focus on effective and appropriate NHS services.
Some of the most common interventions which are deemed to be ‘of limited clinical value’ (this depends on your perspective of course; it may be important to you) are classified into 2 groups. Below are examples from one CCG. Your area may be different.
Category 1. Interventions that are NOT routinely commissioned (paid for), with patients only able to access such treatments where they successfully make an Individual Funding Request (IFR; see below):
- Snoring interventions
- Dilatation and curettage for heavy menstrual bleeding
- Knee arthroscopy
- Injections for low back pain (without sciatica)
- Endoscopic thoracic sympathectomy for blushing or sweating
- Certain cosmetic procedures
- Certain female genital operations to alter appearance
- Certain treatments for excessive sweating
Category 2. Interventions that can be commissioned when specific and possibly favourable criteria are met:
- Breast reduction
- Removal of benign skin lesions (cysts and fatty lumps)
- Grommets in ears
- Gallstone surgery
- Tonsillectomy
- Bunion surgery
- Hernia surgery
- Haemorrhoid surgery
- Hysterectomy for heavy bleeding
- Female prolapse
- Male circumcision
- Chalazia removal (benign eyelid cysts and lumps)
- Shoulder decompression
- Carpal tunnel syndrome release (trapped nerve at the wrist)
- Dupuytrens contracture release (scarring of the palm causing finger deformity)
- Ganglion excision (cysts projecting from joints such as wrists)
- Trigger finger release
- Varicose vein surgery
- Hip and knee replacement
- Cataract surgery
- Certain nose operations
- Assisted conception
If a patient’s condition does not meet the criteria as agreed with the local ICB, then a special appeal process called an Individual Funding Request (IFR) can be requested. This is normally where a patient or doctor requests an intervention not usually funded, but they believe the patient will receive significantly more benefit than most patients. This is a video about IFRs.
The application to an ‘IFR panel’ at the ICB is normally supported in writing by a doctor (usually a specialist) using a bespoke form for the purpose, quoting evidence to support their belief of anticipated exceptional gain. If approved, the procedure will be funded. If rejected, the procedure will not be funded unless the findings of the panel are overturned on appeal.
The rules allow ICBs to set strict criteria to be met before a hospital performs an intervention. If the criteria are not met, the hospital runs the risk of not being paid for its work – if prior approval is not met or if an IFR has not been successful.
Summary
We have described NHS low priority procedures (LPPs). We hope it has been helpful.
