Evidence Based Interventions (EBI)

When we spend money on health and care services for the people of Bath and North East Somerset, Swindon and Wiltshire, we take into account the needs of the whole population.

The demand for our services is always greater than the money we have available, so it is not possible for us to fund every available treatment. This means we sometimes have to make difficult decisions regarding which treatments are routinely provided.

BSW ICB has a set of policies and procedures in place in order to reduce variation of care provision across England, follow the principles of good medical practice and limit the number of procedures of limited clinical value (PLCV).

We refer to the NHS Evidence-Based Interventions Programme (EBI) for guidance. Its aim is to manage and prevent avoidable harm to patients, to avoid unnecessary operations, and to free up clinical time by only offering treatment on the NHS that is evidence-based and is clinically effective.

Our Evidence Based Intervention Clinical Policies listed below outline whether an intervention is not normally funded (INNF) or whether the intervention has a clinical criteria threshold to access treatment and is therefore either criteria based access (CBA) or prior approval (PA) is required. It is the responsibility of the clinicians and referrers to ensure patients meet the policy criteria before referring or commencing treatment.

We know, however, that there are times when you could benefit from a particular treatment that is not usually funded by us. Your GP or Consultant may make a request on your behalf for such a treatment if they feel there are exceptional clinical circumstances related to your case. This request is called an Exceptional Funding Request (EFR).

View If I pay for private treatment, how will my NHS care be affected?

View the BSW ICB - Exceptional Funding Requests, Prior Approval & Criteria Based Access Policy

View the Statement on European Cross Border Health Care

View advice for Getting as fit as possible for surgery

View the General Principles for Funding Approval

View the BSW CP091 - Management of patients moving in and out of BSW

View the Medicines Management Team Advisory Summary for Private Treatments

 

Bath and North East Somerset, Swindon and Wiltshire ICB Funding Policies

For a small number of treatments, individual policies for each locality still apply. View locality-specific policies for BaNES, Swindon and Wiltshire.

BSW Prior Approval Application Form Generic form if there is no specific procedural form available for the condition in question
BSW Exceptional Procedures Application Form Generic form for all exceptional procedural requests. Please use the form below for medicines, devices or drug related requests, as the level of information requested on this form will not be sufficient for the committee to make an informed decision
BSW Exceptional Medicines Application Form Generic form for all exceptional medicine, device and drug related requests.

 

Condition

Funding Criteria
Abdominoplasty / Apronectomy policy Indication Not Normally Funded- Exceptional Funding Required
Adenoidectomy (Under 18) policy Criteria Based Access
Aesthetic Surgery policy Indication Not Normally Funded- Exceptional Funding Required
Assisted Conception (IVF) policy

Assisted Conception - IVF Criteria Checklist

 Prior Approval
Preservation of Fertility policy Criteria Based Access
Blepharoplasty and Ptosis (18 and over) policy

Blepharoplasty and Ptosis application form

 Prior Approval
Body Contouring Indication Not Normally Funded- Exceptional Funding Required
Botulinum Toxin for Anal Fissure policy

Botulinum Toxin for Anal Fissure application form

 Criteria Based Access (1st Treatment)

Prior Approval (Subsequent Treatment)
Botulinum Toxin for Bladder Dysfunction policy Criteria Based Access
Botulinum Toxin for Focal Spasticity policy

Botulinum Toxin for Focal Application form

 Prior Approval
Botulinum Toxin for Other Treatments policy Various Specific Criteria
Breast Reconstruction (Post Cancer & Risk Reduction) policy Exceptional (Secondary Care Specialists Only)
Breast Surgery Cosmetic policy Indication Not Normally Funded- Exceptional Funding Required
Brow Lift Surgery policy Indication Not Normally Funded- Exceptional Funding Required
Bunions (Surgical) policy

Bunions (Surgical) application form

 Prior Approval
Carpal Tunnel Syndrome (Inc. Revision Surgery) policy

Carpal Tunnel Syndrome (Inc. Revision Surgery) application form

 Prior Approval (Required for Secondary Care Referrals)
Cataracts policy Criteria Based Access
Chalazion Treatment policy

Chalazion Treatment application form

 Prior Approval
Cholecystectomy policy Criteria Based Access
Chronic Fatigue Syndrome policy Indication Not Normally Funded- Exceptional Funding Required
Circumcision policy

Circumcision application form

 Prior Approval
Complementary & Alternative Therapies policy Indication Not Normally Funded- Exceptional Funding Required
Diabetes CGM Adults & Children policy Criteria Based Access
Diastasis of Recti policy Indication Not Normally Funded- Exceptional Funding Required
Discectomy policy Criteria Based Access
Dupuytrens Surgery policy

Dupuytrens Surgery application form

 Prior Approval
Eye – Ectropion Surgery policy

Eye – Ectropion Surgery application form

 Prior Approval
Eye – Entropion Surgery policy Criteria Based Access
Exogen® (Low-intensity Pulsed Ultrasound for Fracture Healing (LIPUS) policy Indication Not Normally Funded- Exceptional Funding Required
Female Genital Cosmetic Surgery policy Indication Not Normally Funded- Exceptional Funding Required
Functional Electrical Stimulation for Drop Foot (FES) policy Criteria Based Access
Ganglia policy

Ganglia application form

 Prior Approval
Grommets in Adults & Children policy Criteria Based Access
Haemorrhoids policy Criteria Based Access
Hair - Wigs, Hairpieces & Hair Transplant / Replacement policy Indication Not Normally Funded- Exceptional Funding Required
Heavy Menstrual Bleeding (Menorrhagia) policy Criteria Based Access (For Secondary Care Referrals)

Indication Not Normally Funded- Exceptional Funding Required (For Dilation & Curettage)
Hernia in Adults policy Criteria Based Access
Hip and Knee Replacement policy Criteria Based Access
Hirsutism policy Indication Not Normally Funded- Exceptional Funding Required
Knee Arthroscopy policy Criteria Based Access
Micro Suction (18 & Over) - Management of Earwax policy Criteria Based Access
Nasal Surgery – Septoplasty, Septorhinoplasty & Rhinoplasty policy Various Criteria
Nasal Surgery - Chronic Rhinosinusitis policy Criteria Based Access
Open MRI policy

Open MRI application form

 Prior Approval
Pinnaplasty policy Indication Not Normally Funded- Exceptional Funding Required
Reversal of Sterilisation policy Indication Not Normally Funded- Exceptional Funding Required
Shoulder Pain Management policy Various Criteria
Skin Lesions (Benign) policy

Skin Lesions (Benign) application form

 Prior Approval
Skin Lesions (Basal Cell Carcinoma) policy Policy Statement
Snoring (18 & Over) policy Indication Not Normally Funded- Exceptional Funding Required
Spinal Pain (Neck & Lower Back) policy

Spinal Pain (Neck & Lower Back) application form

 Various Specific Criteria
Tonsillectomy (Children & Adults) policy

Tonsillectomy (Children & Adults) application form

 Prior Approval

Criteria Based Access (Peritonsillar Abscess - Quincy)
Trigger Finger Release (18 & Over) policy

Trigger Finger Release (18 & Over) application form

 Prior Approval
Varicose Veins policy

Varicose Veins application form

 Prior Approval

 

Locality Specific Policies

BaNES Policies

Please note: RUH tier 3 Weight Management is now open to direct referral for all of the BSW geography

Swindon Policies

None listed.

Wiltshire Policies

None listed.