Decision of the Governing Body

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.