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Treatments_that_need_Prior_Approval

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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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