Commissioning Policy Individual Funding Request

Transcription

1 Commissioning Policy Individual Funding Request Surgical Foot Treatments: Including Bunions, Toe Deformity, Morton s Neuroma and Plantar Fasciitis Prior Approval Policy Date Adopted: 16 th September 2016 Version: v Individual Funding Request Team - A partnership between Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Commissioning Group

2 Document Control Title of document Authors job title(s) Surgical Foot Treatments: Including Bunions, Toe Deformity, Ingrown Toenails, Morton s Neuroma and Plantar Fasciitis Policy IFR Manager Document version v Supersedes Bunion / Lesser Toe Deformity Policy v Clinical approval February 2016 Discussion and Approval by 13th April 2016 Clinical Policy Review Group (CPRG) Discussion and Approval by CCG 3 rd May 2016 Board Date of Adoption: 16 th September 2016 Publication/issue date 16 th September 2016 Review date September 2016 Application Form Version Control V Equality and Impact Assessment

3 TREATMENT UNDER THIS POLICY REQUIRES PRIOR APPROVAL FROM THE CCG INDIVIDUAL FUNDING TEAM THIS POLICY RELATES TO ALL PATIENTS Surgical Foot Treatments: Including Bunions, Toe Deformity, Morton s Neuroma and Plantar Fasciitis Policy Statement & Date of Adoption: 16 th September 2016 Surgical Foot Treatments: Including Bunions, Toe Deformity, Morton s Neuroma and Plantar Fasciitis are not routinely funded by the CCG and are subject to this restricted policy. General Principles Funding approval will only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval will not be given. 1. Patients should be referred to Musculoskeletal (MSK) Services for assessment and conservative treatment before surgical options are considered. Musculoskeletal services will assess a patient s suitability for surgery including reference to this policy, manage patients conservatively when possible and where appropriate refer patients to secondary care for further management of their condition. Bristol Musculoskeletal Assessment and Treatment Service (MATS) and Spinal Service North Somerset The Musculoskeletal Interface Service South Glos - Clinical/Spinal Assessment & Treatment Service 2. Funding approval must be secured by the patient s treating clinician prior to referring patients for surgical opinions. Referring patients to secondary care without funding approval having been secured not only incurs significant costs in out-patient appointments for patients that may not qualify for surgery, but inappropriately raises the patient s expectation of treatment. 3. On limited occasions, the Clinical Commissioning Group (CCG) may approve funding for an assessment only in order to confirm or obtain evidence demonstrating whether a patient meets the criteria for funding. In such cases, patients should be made aware that the assessment does not mean that they will be provided with surgery and surgery will only be provided where it can be demonstrated that the patients meets the criteria to access treatment in this policy. 4. Where funding approval is given by the Individual Funding Request Panel, it will be available for a specified period of time, normally one year. 5. Funding approval will only be given where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where it is demonstrated that patients have previously been provided with the treatment with limited or

4 diminishing benefit, funding approval is unlikely to be agreed. 6. The CCG does not commission treatment and surgery for cosmetic purposes alone. Background Conditions and Treatments included in this policy: Bunions (National Institute for Health and Care Excellence, 2010) Hallux valgus (often referred to as a bunion) is the deviation of the big toe (the hallux) away from the mid-line towards the lesser toes. The metatarsal head drifts towards the midline and this together with its overlying bursa and inflamed soft tissue is known as the bunion, which causes pain and rubbing on shoes. Hallux Rigidus (Royal College of Surgeons, 2013) The development of arthritic changes within the joint causing stiffness, pain and deformity. Hammer Toe (Royal College of Surgeons, 2013) Hammer toe or contracted toe is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer. Mallet Toe (Royal College of Surgeons, 2013) A similar condition to hammer toe affecting the distal interphalangeal joint. Claw Toe (Royal College of Surgeons, 2013) Another similar condition to hammer toe, with dorsiflexion of the proximal phalanx on the lesser metatarsophalangeal joint, combined with flexion of both the proximal and distal interphalangeal joints. Claw toe can affect the second, third, fourth, or fifth toes. Plantar Fasciitis (NHS Choices, 2014) Also known as plantar fasciopathy or jogger's heel is a common painful disorder affecting the heel and underside of the foot. Morton s Neuroma (NHS Choices, 2015) A condition that affects one of the nerves between the toes. It's also known as Morton's metatarsalgia or interdigital neuroma. In Morton's neuroma, fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes along with paraesthesia (numbness) into the toes. It is expected that the vast majority of patients with foot conditions and mild pain will be managed in primary care by providing patients with appropriate practical information on managing their symptoms such as pain relief and footwear modification (lower heels, wider fitting shoes, high toe

5 box). This advice and conservative treatment must be documented as it will form evidence to support part of the access criteria for this intervention. Policy - Criteria to Access Treatment - PRIOR APPROVAL REQUIRED Requests for Surgical Foot Treatments will be approved where the following criteria are met: 1. Where a minimum of 12 weeks of conservative treatments has been evidenced with primary care (this can include MSK clinic letters). AND 2. a. The patient is suffering from severe deformity overriding toes which is causing significant functional impairment* OR 2. b. The patient is suffering from severe pain which is causing significant functional impairment* * Significant functional impairment is defined by the BNSSG Health Community as: - Symptoms preventing the patient fulfilling routine work or educational responsibilities - Symptoms preventing the patient carrying out routine domestic or carer activities Surgery is NOT routinely funded for concerns about the appearance of feet. Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed at the CCG s Individual Funding Request Panel upon receipt of a completed application form from the patient s GP, consultant or clinician. Applications cannot be considered from patients personally. If you would like further copies of this policy or need it in another format, such as Braille or another language, please contact the Patient Advice and Liaison Service on or Related Policies: Ganglions: Treatment will not be offered under this policy. Clinician s should refer to the intervention specific policy. Benign Skin Lesions: Treatment will not be offered under this policy. Clinician s should refer to the intervention specific policy. Cosmetic Surgery: Treatment will not be offered under this policy. Clinician s should refer to the

6 intervention specific policy. Syndactyly: Treatment will not be offered under this policy. Clinician s should refer to the intervention specific policy. Ingrown Toenail Care in Secondary Care: Treatment will not be offered under this policy. Clinician s should refer to the intervention specific policy. This policy has been developed with the aid of the following references: National Institute for Health and Care Excellence. (2014, February). Osteoarthritis: care and management. Retrieved from NICE org: National Institute for Health and Care Excellence. (2010, February). Surgical correction of hallux valgus using minimal access techniques. Retrieved from NICE Org: NHS Choices. (2014, October 16). Heel pain. Retrieved from NHS Choices: NHS Choices. (2015, August 20). Morton's neuroma. Retrieved from NHS Choices: Royal College of Surgeons. (2013, November). Painful Deformed Great Toe in Adults. Retrieved from Royal College of Surgeons: Approved by (committee): Clinical Policy Review Group Date Adopted: 16 th September 2016 Version: Produced by (Title) EIA Completion Date: Review Date: Commissioning Manager Individual Funding Undertaken by (Title): Earliest of either NICE publication or three years from approval. CATEGORY VERSION CATEGORY VERSION CATEGORY VERSION Bristol Prior Approval North Somerset Prior Approval South Gloucestershire Prior Approval