Adherence to evidence based medicine

Decision of the Governing Body on the Adherence to Evidence Based Medicine Consultation

Consultation Proposals:

The Adherence to Evidence Based Medicine consultation proposed to revise clinical criteria for some treatments currently available on the NHS. This consultation proposed to:

  1. Expand the list of treatments included within the North Central London Procedures of Limited Clinical Effectiveness (PoLCE) policy.
  2. Introduce additional clinical criteria for knee replacements.
  3. Decommission homeopathy services.

Responses received during the consultation period of 1 March 2017- 30 June 2017:

We received a total of 481 responses to the consultation. Details are provided in The Campaign Company’s report.

We would like to thank everyone for their contributions to this consultation, including the submissions from the following:

  • Action on Hearing Loss
  • British Academy of Audiology
  • British Orthopaedic Association
  • British Society of Audiology
  • Defend Enfield NHS
  • Good Thinking Society
  • Healthwatch Enfield
  • National Community Hearing Association
  • Nightingale Collaboration
  • Royal free London Foundation Trust
  • Specsavers

Every contribution to the consultation was considered individually and all the feedback was analysed by The Campaign Company to compile an independent consultation report.

Decision of the Governing Body at its meeting on 20 September 2017

The CCG carefully considered the feedback received from patients and stakeholders and the recommendations of the Clinical Reference Group regarding the clinical evidence available before arriving at its decision.

 The Governing Body decided NOT to proceed with the following proposals:

  • Hearing Aids: The CCG will not change the access policy for hearing aids or add them to the PoLCE policy, but should instead introduce outcome measures for providers to ensure that those patients provided with NHS Hearing Aids get the best treatment and outcomes for the money invested.We will also work with the organisations that provided feedback on hearing aids to achieve improved outcomes for patients. 
  • Knee Replacements: The CCG will not be proceeding with the proposals to change the access criteria in certain circumstances (such as patients with very high BMI who have low levels of pain) where the clinical evidence suggests that knee replacements may not deliver the most optimal outcomes. It was felt that the support services needed by patients to help them lose weight and make other lifestyle changes such as additional therapies community physiotherapy and stop smoking, are fragmented and therefore until this is resolved we could not proceed at this time. We will seek to introduce the changes when there is sufficient assurance that patients will be able to access the support they need to make the lifestyle changes necessary and to access appropriate alternative services. This will be subject to a further public paper (but no further consultation) at the appropriate time in the future and the Equality Impact Assessment (EIA) will be updated at that time.

The Governing Body has decided to proceed with the following:

Of the additional treatments proposed to be included in the Procedures of Limited Clinical Effectiveness (PoLCE) policy, the Governing Body has agreed that to progress with 10 of them following further review of the clinical evidence by GPs and the updated equality impact assessment, on the basis that:

  • these proposals are clinically appropriate and will not have any negative effect on safety, outcomes or equality for patients
  • no new evidence was presented during the consultation

 These are:

  • Bunions
  • Hernia
  • Vasectomy
  • Uterovaginal prolapse
  • Revision mammoplasty
  • Revision of hypertrophic scars
  • Penile procedures
  • Cholecystectomy for gallstones
  • Chalazions
  • correction of ptosis 

It has also decided to proceed with decommissioning homeopathy services following a thorough review of all the clinical evidence.




Adherence to Evidence Based Medicine Consultation: Enfield CCG statement 24 April 2017

Following the announcement of the General Election, we are now in the pre-election period, which means that as of today, 24 April 2017, Enfield CCG will:

  • be postponing any scheduled public meetings where discussion or decisions on the Adherence to Evidence Based Medicine programme take place
  • not make any public statements or carry out any public engagement on changes to NHS services – this includes social media, websites and traditional media except for routine health messages
  • be extending the consultation period to 30 June 2017 to take into account the pre-election period and allow time for the events that are postponed to be rescheduled. The consultation remains open and you can access the documents and the online survey below.

 We want to hear your views about our Adherence to Evidence Based Medicines Programme

 Enfield Clinical Commissioning Group, along with our North Central London colleagues, wants to the secure the greatest health impact it can with its resources by adhering as closely as possible to the clinical evidence base available.

There is considerable national and international evidence that many procedures offered routinely by the NHS are of limited clinical benefit to patients in some or all circumstances. Therefore there needs to be careful consideration as to whether or not a procedure is going to be of any benefit to an individual patient before deciding to undertake it. To do this we must use the best and most up to date clinical advice and evidence to ensure we have the best chance of delivering a benefit to each individual patient who is put forward for treatment. This  evidence published by the National Institute for Health & Care Excellence(NICE) as well as available evidence published by the Royal Colleges and other Clinical Commissioning Groups. This will also ensure the best value from the services we commission.

To ensure this decision making process is applied consistently, Enfield Clinical Commissioning Group along with the other Clinical Commissioning Groups in North Central London, adopted a common policy concerning these procedures that have limited clinical effectiveness in 2012 based on the best available evidence at that time.

As the clinical evidence base moves on we are now undertaking a further review to ensure that we are using the best and latest clinical evidence in our decision making. We are also looking at the range of procedures where the evidence base now suggests we need to make changes to the guidance for individual patient situations to avoid the risk of undertaking procedures that have little or no benefit to patients or even where the undertaking of the procedure could result in a risk of harm. We have published the evidence we reviewed here.

Clinical Leaders at the Clinical Commissioning Group with the full support of the Governing Body are leading this review. Enfield Clinical Commissioning Group will engage widely and consult formally on the proposals which emerge, while continuing to work closely with partner Clinical Commissioning Groups in North Central London.

The consultation started on 1 March 2017 and closed on 30 June 2017.

You can download the consultation document on the sidebar, along with the equality impact assessment and you can fill in the questionnaire.

List of consultation events:

Friday 23rd June at 2.00pm The Ruth Winston Centre 190 Green Lanes, N13 5UE

Event notes

Patient and Public Engagement Event: Wednesday 21 June 9:30am-1pm Cockfosters Centre for Spirituality, 29 Bramley Road, N14 4HE  

Monday 19 June 6-7:30pm Enfield Island Community Centre, 42 Island Centre Way, EN3 6GS

Event notes

Thursday 15 June 2-4pm Southgate Beaumont Care Home, Southgate House, 15 Cannon Hill, Arnos Grove, London, N14 7DJ

Event notes

Local area forum Winchmore Hill 19 April (Organised by Enfield Councillors)

Event notes

Thursday 30 March 2017 2pm-4pm – Community House, 311 Fore Street, Edmonton N9 0PZ Hosted by Enfield Voluntary Action

Event Flyer 


Event notes

Wednesday 22 March 2017 2pm-4pm – Community House,311 Fore Street, Edmonton N9 0PZ Hosted by Healthwatch Enfield

Event Flyer


Event notes

Wednesday 1 March 2017 10am-1pm, Executive Suite at the Dugdale Centre, 39 London Road, Enfield, EN2 6DS.

 If you would like the document in another format or if you have any other queries, please contact or call 0203 688 2814.