Our clinical policies
Not all treatments and medications are routinely funded on the NHS. This is because the effectiveness of certain procedures and medications can vary significantly amongst patients, so for some people treatments can be more harmful than they are helpful.
The NHS has a responsibility to make sure it is using its limited resources in a way that gives patients the most health benefits and best outcomes.
The CCGs have a range of clinical policies which outline the treatments and procedures we fund and details of who may be eligible to receive them.
Treatments can be simply broken down into three areas:
- Treatments routinely available through the NHS
- Treatments available through the NHS by ‘prior approval process’ to those who meet key clinical policy criteria
- Treatments not currently funded and only available on the NHS through the process of an individual funding request
Our finalised clinical policies,which provide a framework to help aid the decision-making process for the funding of specific treatments or procedures, are housed within the folder Clinical policies documents folder in our Document Store.
Please note this list is not an exclusive list of procedures and different procedures within the same policy may have different criteria.
Your local GP or CCG will be able to provide you with information on your specific medical need.
Your doctor will talk to you about your condition. If you do not meet the criteria for surgery this means that surgery could be more harmful than helpful. Your doctor will be able to suggest alternative non-surgical treatments which can also be highly effective at improving your symptoms.
If your GP thinks you do meet the criteria, you will be referred to a consultant for a specialist opinion
Seeing a specialist
The consultant will review your symptoms and history and if they think that you will benefit from surgery they will request funding from the CCGs to perform the procedure. Your case will be reviewed by the prior approvals team to confirm that the criteria has been met and your consultant will be contacted as soon as possible to inform them of your eligibility for surgery.
If funding is approved you will be contacted by the hospital to arrange a further appointment.
If funding is not approved, you have not met the criteria. This means that surgery will not be the most effective treatment for your symptoms and could be more harmful than helpful. The hospital will contact you to inform you of the outcome and you will be advised of next steps regarding your treatment.
If your circumstances change, the consultant may be able to reapply for funding. Your GP will be able to advise you in these instances.
If your treatment has been subject to the prior approvals process and you would like to feedback or complain about the outcome, please visit the contact us section of this website.
If you have a medical condition you or your doctor feels is exceptional and might benefit from a treatment that falls under a clinical policy that does not allow for the prior approval process to be applied, and the treatment is not funded, an individual funding request is required.
Click here to access more information on individual funding.
Policies under review - have your say
Please note, any policies under review and eligible for public feedback will be displayed below.
Please check back in future to see policies under review.