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Treatments that need Prior Approval from NHS Peterborough Why certain treatments require prior approval? NHS Peterborough must provide health care to it’s population within it’s budget. To do this NHS Peterborough gives a higher priority to treatments known to offer the most health benefits to patients in the most cost effective way, for example, hip replacements. For certain types of treatment NHS Peterborough asks that GPs and or Consultants request prior approval for funding. These treatments include those which; Have little evidence they are effective in treating patients (e.g. aromatherapy) Only effective in certain situations (e.g. varicose vein surgery, Botox therapy) Are for cosmetic reasons only (breast augmentation, laser hair removal) NHS Peterborough assess applications made by GPs and or Consultants against criteria set out in policies created by the Cambridgeshire and Peterborough Clinical Priorities Forum. This Forum advises NHS Peterborough, and establishes policies which detail the circumstances low priority treatment should be made available under the NHS. These policies can be found at www.cambsphn.nhs.uk . Who decides what treatments are funded and when? NHS Peterborough has established a Clinical Review Group to consider cases requiring prior approval. This panel is made up of clinical and non clinical staff, including the organisations’ Medical Director, Public Health Consultant and health commissioners. The Clinical Review Group reviews cases against the criteria of the Clinical Priorities Forum policies, when appropriate. The Clinical Review Group also considers whether there are any exceptional features of the case, if the criteria is not met, or when there is no policy to refer to. It is the responsibility of your GP or Consultant to demonstrate exceptional individual circumstances. How does the Clinical Review Group work? If your doctor or consultant has made an application to the Clinical Review Group the request will be acknowledged and then considered at the next meeting. This group meets fortnightly to consider the large number of applications that NHS Peterborough receives for prior approvals. The majority of decisions are responded to within a month, unless further evidence/support is required. The Clinical Review Group will consider applications for funding in line with guidance and policies established locally by NHS Peterborough, the Cambridgeshire & Peterborough Clinical Priorities Forum and East of England Specialist Commissioning Group, as well as national polices such as those issued National Institute for Clinical Excellence. Decisions are always communicated back to the referring clinician, and therefore you must contact your GP or Consultant to discuss the outcome of your case. If the Clinical Review Group agrees that you have met the established criteria of a policy or the case has exceptional features, the relevant clinician will refer you on to treatment. If the Clinical Review Group thinks that you do not fulfil the criteria of an established policy or the case has no exceptional features, this will be included in the letter to the referring clinician. If you or your referring GP/Consultant do not agree with this decision an appeal can be made in writing to NHS Peterborough within 28 days.
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