Since their inception in 2012 CCGs have had to contend with growing financial restrictions. In their quest to deliver better value for money CCGs have identified Procedures of Limited Value (POLCV) as an area for review.
POLCV which have traditionally included complimentary or alternative treatments, aesthetic treatments, or treatments without NICE guidance of cost-effectiveness, are now increasingly the subject of scrutiny. It falls to commissioners to ensure that public funding is directed to best meet the health needs of the population and this means making tough decisions about the value of procedures.
South Eastern Hampshire CCG comments that the decision to exclude certain treatments reflects an approach that is both efficient and fair for patients, taking into account the health needs of the whole community. ‘As there is only a set amount of money available to spend we sometimes have to make difficult decisions about which treatments are not routinely provided’ (South Eastern Hampshire CCG).
What are the perceived savings?
New Devon CCG estimated that restricting POLCV would save the CCG around £8 million per year, they also suggest that further savings could be made by restricting other low priority procedures (current spend of £22 million), going some way towards reducing their current deficit.
Implications for users
Inappropriate GP referrals made for POLCV will be returned to the GP with an explanatory letter (NHS Devon). Where exceptional clinical need is demonstrable individual referrals may be reviewed by a designated panel.
psHEALTH’s referral management software can be configured to local policies, so that POLCV are flagged immediately and the GP notified, avoiding unnecessary delays. Furthermore commissioners are empowered through real-time data, ensuring improvement and refinement of local care pathways.
“We are looking to referral management to help us identify and reduce these procedures of limited clinical value,” says one CCG CFO who did not want to be named. “The SUS data is helpful for many purposes, but actually capturing appropriate referrals at the point of the GP making the referral is much more powerful in terms of changing behaviour,” she added.