Commissioning policies for criteria-based clinical procedures

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.

Every NHS Integrated Care Board (ICB) is responsible for determining the range and level of clinical/medical services provided to the public it serves. In doing so ICBs are legally obliged to develop and publish any policies it has adopted to determine the availability of specific treatments or procedures for the local population.

The main objective for having a clinical commissioning policy is to ensure that:

• Patients receive appropriate, evidence-based health treatments in the right place, at the right time
• Treatments that are routinely undertaken represent the most effective and cost- effective use of the limited resource available
• Treatments with no or a very limited clinical evidence base are not routinely undertaken 
• Treatments with minimal health gain are restricted
• The risk of avoidable harm is reduced.  With all surgical interventions, there is always a risk of complications and adverse effects which could be avoided
• Clinicians are assisted in maintaining their professional practice in line with the changing evidence base
• Available resources are maximized, and waste is avoided as ineffective care is poor value for money for the taxpayer and the NHS.

The ICB has a range of clinical commissioning policies which outline the treatments and procedures we fund and details of who may be eligible to receive them. A full list of existing policies can be found via the links at the bottom of this page.

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 will be able to provide you with information on your specific medical need.

Exceptionality and Individual Funding Requests

Reference to exceptionality and the exceptionality policy is built into every clinical commissioning policy.  If a treatment or procedure is not normally funded or you do not meet the access criteria, but your clinician (consultant/GP or other health professional) feels there are exceptional circumstances and you would benefit from this treatment, then your clinician can submit an Individual Funding Request (IFR). This is submitted on your behalf on the grounds of exceptionality to the policy.

Only a clinician can submit an IFR. 

Clinical commissioning policies under development or review – have your say

Any new clinical commissioning policy that is being created must follow a rigorous process of development, which includes ensuring patients and members of the public can contribute to this process. 

It is also the responsibility of ICBs to review clinical policies on a regular basis.  This is done to ensure that changes in best clinical practice are considered, including national guidance from NICE and other bodies.  It also means updates as a result of new legislation or legal decisions can be made to existing policies.  All clinical policies have a review date, which is usually within two or three years of their adoption.

There are currently no policies under review. Please check back in future to see policies under review.