New Treatment Policies


Since 2013 the following Clinical Commissioning Groups (CCG) and their respective Local Authority Public Health Commissioners have worked collaboratively to develop this harmonised core set of 21 treatment policies:

  • NHS Birmingham CrossCity CCG
  • NHS Birmingham South Central CCG
  • NHS Sandwell and West Birmingham CCG
  • NHS Solihull CCG
  • NHS Walsall CCG
  • NHS Wolverhampton CCG
The aim is to:

  • ensure policies incorporate the most up-to-date published clinical evidence so that we prioritise funded treatments that are are proven to have clinical benefit for patients.
  • stop variation in access to NHS funded services across Birmingham, Solihull and the Black Country (sometimes called the ‘postcode lottery’ in the media) and allow fair and equitable treatment for all local patients.
  • ensure access to NHS funded treatment is equal and fair, whilst considering the needs of the overall population and evidence of clinical and cost effectiveness.
Birmingham CrossCity, Birmingham South Central and Solihull CCGs undertook period of public engagement in early 2016 to ensure that patients and other stakeholders had the opportunity to give their views on the proposed new harmonised policies. 

 pdfThe final engagement report can be read here (3.46 MB)

 pdfView the Harmonised Treatment Policies Equality Assessment Report here (842 KB)  

View the Glossary of Terms for Treatment Policies here

 pdfView the Harmonised Treatment Policies Document here (1.15 MB)

View the Harmonised Treatment Policies Acute Provider Implementation notice letter here

View the Harmonised Treatment Policies Finance/Activity trend analysis - 17/18 latest here

View the Treatment Policies Reference Library here

Restricted procedures

Not normally funded procedures

Which treatments are covered by policies?

Policy Document Treatment Policy Category Treatment Policy Detail Patient Treatment Leaflet
Adenoidectomy   Restricted   documentAdenoidectomy(76 KB) Adenoidectomy
Cosmetic Surgery Abdominoplasty / Apronectomy              Not routinely commissioned  documentAbdominoplasty / Apronectomy (75 KB) documentAbdominoplasty / Apronectomy
Cosmetic Surgery Thigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat            Not routinely commissioned  documentThigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat (75 KB)   Thigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat
Cosmetic Surgery Liposuction Not routinely commissioned  documentLiposuction (74 KB) Liposuction
Cosmetic Surgery Breast Augmentation
a) Non breast cancer
b) Breast cancer
Not routinely commissioned
 documentBreast Augmentation (76 KB) Breast Augmentation
Cosmetic Surgery Breast Reduction
a) Non breast cancer
b) Breast cancer      

Not routinely commissioned
 documentBreast Reduction(78 KB) documentBreast Reduction
Cosmetic Surgery Mastopexy (Breast Lift)
a) Non breast cancer
b) Breast cancer

Not routinely commissioned
 documentMastopexy (Breast Lift) (76 KB) documentMastopexy (Breast Lift)
Cosmetic Surgery Inverted Nipple Correction
a) Non breast cancer
b) Breast cancer

Not routinely commissioned 
 documentInverted Nipple Correction (75 KB) Inverted Nipple Correction
Cosmetic Surgery Gynaecomastia (Male Breast Reduction) Not routinely commissioned   documentGynaecomastia (Male Breast Reduction) (75 KB) Gynaecomastia (Male Breast Reduction)
Cosmetic Surgery Labiaplasty Restricted   documentLabiaplasty (76 KB) documentLabiaplasty
Cosmetic Surgery Vaginoplasty Restricted   documentVaginoplasty (76 KB) Vaginoplasty
Cosmetic Surgery Pinnaplasty Not routinely commissioned   documentPinnaplasty (75 KB) documentPinnaplasty
Cosmetic Surgery Repair of Ear Lobes Not routinely commissioned   documentRepair of Ear Lobes (75 KB) Repair of Ear Lobes
Cosmetic Surgery Rhinoplasty Restricted   documentRhinoplasty (75 KB) Rhinoplasty
Cosmetic Surgery Face Lift or Brow Lift (Rhytidectomy) Restricted   documentFace Lift or Brow Lift (Rhytidectomy) (76 KB) documentFace Lift or Brow Lift (Rhytidectomy)
Cosmetic Surgery Hair Depilation (Hirsutism) Restricted  documentHair Depilation (Hirsutism)  (76 KB) documentHair Depilation (Hirsutism)
Cosmetic Surgery Alopecia (Hair Loss) Not routinely commissioned  documentAlopecia (Hair Loss) (75 KB) documentAlopecia (Hair Loss) 
Cosmetic Surgery Removal of Tattoos / Surgical correction of body piercings and correction of respective problems Not routinely commissioned   documentRemoval of Tattoos / Surgical correction of body piercings and correction of respective problems(75 KB) Removal of Tattoos / Surgical correction of body piercings and correction of respective problems
Cosmetic Surgery Removal of Lipomata Restricted  documentRemoval of Lipomata (75 KB) Removal of Lipomata
Cosmetic Surgery Removal of Benign or Congenital Skin Lesions Restricted   documentRemoval of Benign or Congenital Skin Lesions (76 KB) Removal of Benign or Congenital Skin Lesions
Cosmetic Surgery Medical and Surgical Treatment of Scars and Keloids Not routinely commissioned   documentMedical and Surgical Treatment of Scars and Keloids(76 KB) documentMedical and Surgical Treatment of Scars and Keloids
Cosmetic Surgery Botulimium Toxin Injection for the Ageing Face Not routinely commissioned   documentBotulimium Toxin Injection for the Ageing Face (75 KB) Botulimium Toxin Injection for the Ageing Face
Cosmetic Surgery Treatment for Viral Warts Restricted   documentTreatment for Viral Warts (75 KB) Treatment for Viral Warts
Cosmetic Surgery Thread / Telangiectasis / Recticular Veins Not routinely commissioned   documentThread / Telangiectasis / Recticular Veins (76 KB) Thread / Telangiectasis / Recticular Veins
Cosmetic Surgery Rhinophyma Not routinely commissioned   documentRhinophyma (75 KB)  documen
Cosmetic Surgery Resurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment Not routinely commissioned  documentResurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment (75 KB) Resurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment
Cosmetic Surgery Other Cosmetic Procedures Not routinely commissioned   documentOther Cosmetic Procedures (77 KB) Other Cosmetic Procedures
Cosmetic Surgery Revision of Previous Cosmetic Surgery Procedures Not routinely commissioned   documentRevision of Previous Cosmetic Surgery Procedures(74 KB) documentRevision of Previous Cosmetic Surgery Procedures
Back Pain
  Restricted   documentBack Pain (139 KB) 
documentBack Pain
Botulinium Toxin for Hyperhydrosis   Not routinely commissioned   documentBotulinium Toxin for Hyperhydrosis(74 KB) 
Botulinium Toxin for Hyperhydrosis
Cataracts   Restricted  documentCataracts (229 KB) 
Cholecystectomy for Asymptomatic Gallstones   Not routinely commissioned  documentCholecystectomy for Asymptomatic Gallstones (76 KB) Cholecystectomy for Asymptomatic Gallstones 
Male Circumcision   Restricted  documentMale Circumcision (75 KB) Male Circumcision
Dilation and Curettage (D&C) for Menorrhagia   Not routinely commissioned  documentDilation and Curettage (D&C) for Menorrhagia (74 KB) documentDilation and Curettage (D&C) for Menorrhagia
Eyelid Surgery (Upper and Lower) Blepharoplasty   Restricted  documentEyelid Surgery (Upper and Lower) Blepharoplasty (76 KB) Eyelid Surgery (Upper and Lower) Blepharoplasty
Ganglion    Restricted   documentGanglion (74 KB) documentGrommets
Grommets    Restricted   documentGrommets (75 KB) Grommets
Haemorrhoidectomy    Restricted   documentHaemorrhoidectomy(76 KB) 
Hip Replacement Surgery   Restricted   documentHip Replacement Surgery (79 KB) documentHip Replacement Surgery
Hysterectomy for Heavy Menstrual Bleeding    Restricted   documentHysterectomy for Heavy Menstrual Bleeding (78 KB) Hysterectomy for Heavy Menstrual Bleeding
Diagnostic Hysteroscopy for Menorrhagia    Not routinely commissioned   documentDiagnostic Hysteroscopy for Menorrhagia (73 KB) documentDiagnostic Hysteroscopy for Menorrhagia
Groin Hernia Repair    Restricted   documentGroin Hernia Repair (236 KB) documentGroin Hernia Repair 
Knee Replacement Surgery   Restricted   documentKnee Replacement Surgery (76 KB) Knee Replacement Surgery
Penile Implants    Not routinely commissioned   documentPenile Implants(75 KB) documentPenile Implants
Tonsillectomy    Restricted   documentTonsillectomy (75 KB) Tonsillectomy 
Trigger Finger   Restricted  documentTrigger Finger(75 KB) Trigger Finger
Varicose Veins    Restricted  documentVaricose Veins(76 KB) documentVaricose Veins

What does each policy detail?

Each treatment policy states whether the treatment or procedure is:

  • Not routinely commissioned: would require an Individual Funding request to demonstrate clinical exceptionality or
  • Restricted: funded if particular clinical criteriand thresholds apply
There are also:

  • Short summary explanation of what the procedure entails
  • For ‘Restricted’ procedures what the clinical thresholds for treatment are.
  • Summary of what clinical guidance commissioners have used to inform the detail of the commissioning policy, e.g. NICE, Royal Colleges or Other Clinical Associations
  • Each policy is then subject to an Equality Impact Assessment review.

What types of treatments do the policies cover?

The policies cover range clinical treatments which are:

  • procedures that are identified as being relatively ineffective (e.g. grommets and myringotomy, and certain spinal procedures for back pain) or;
  • identified cosmetic procedures or;
  • effective procedures in mild cases where the balance between benefit and risk is close (e.g. cataract surgery and primary hip or knee replacement) or;
  • effective, but where other cost-effective alternatives should be tried first (e.g. hysterectomy for heavy menstrual bleeding)

Principles underpinning each Treatment Policy

Commissioning decisions by CCG Commissioners are made in accordance with the commissioning principles set out below, and in the Birmingham, Solihull and Black Country CCGs’ Individual Funding Request Policy:

  • CCG Commissioners require clear evidence of clinical effectiveness before NHS resources are invested in the treatment.
  • CCG Commissioners require clear evidence of cost effectiveness before NHS resources are invested in the treatment
  • The cost of the treatment for this patient and others within any anticipated cohort is relevant factor.
  • CCG Commissioners will consider the extent to which the individual or patient group will gain benefit from the treatment
  • CCG Commissioners will balance the needs of each individual against the benefit which could be gained by alternative investment possibilities to meet the needs of the community
  • CCG Commissioners will consider all relevant national standards and take into account all proper and authoritative guidance
  • Where treatment is approved CCG Commissioners will respect patient choice as to where treatment is delivered.

Individual Funding Requests (IFR) and Exceptionality

We recognise there may be exceptional circumstances where it is clinically appropriate to fund each of the procedures listed in this policy and these will be considered on case-by-case basis. Funding for cases where either; a) the clinical threshold criteriis not met, or b) the procedure is not routinely funded, will be considered by the CCGs following application to the CCG’s Individual Funding Request Panel, whereby the IFR process will be applied.

This position is supported by the Solihull CCG ethical-framework-version-1-march-2013.

The Individual Funding Request Policy can be read here.

The Individual Funding Request Application Form can be read here.

Clinician's right to seek specialist advice

In cases of diagnostic uncertainty, the scope of this policy does not exclude the Clinician’s right to seek specialist advice.  This advice can be accessed through a variety of different mediums and can include both face to face specialist contact, as well as different models of consultant and specialist nurse advice and guidance virtually. 

How does the IFR Application System work in practice?

Commissioners, GPs, service providers and clinical staff treating registered patients of the CCGs are expected to implement this policy.  When procedures are undertaken on the basis of meeting the criteria specified within the policy, this should be clearly documented within the clinical notes.  Failure to do so will be considered by the CCGs as lack of compliance.

Patients with problems or conditions that might require treatments included in this policy should be referred to a consultant or specialist only;

  • After a clinical assessment is made by the GP or Consultant; AND
  • The patient meets all the criteria set out in the policy.
GPs wishing to seek a specialist opinion for patients who meet the above criteria, should ensure the essential clinical information is included in the referral letter confirming the patient has been assessed in line with this policy.

GPs, Consultants in Secondary Care and provider finance departments need to be aware that the CCG will not pay for the procedures listed in this policy unless the patient meets the criteria outlined in this policy.

The CCGs recognise there will be exceptional, individual or clinical circumstances when funding for treatments designated as low priority will be appropriate.

Where a treatment is either not routinely funded, or the patient does not meet the specified clinical criteria, this means the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG. 

Individual Funding Requests should only be sent to the respective ‘’ accounts detailed below.  Guidance regarding IFRs and an application form, can be found  pdfhere (763 KB).

See separate  pdfleaflet (141 KB) for more information on Individual Funding Requests (IFRs).

IFR contact information

Individual Funding Request Team
Floor Two, Kingston House
438 High Street
West Bromwich
West Midlands
B70 9LD

Telephone: 0121 611 0470

Email address for Individual Funding Request team at Solihull CCG:   

View the Arden & GEM CSU IFR Team contact list here.          

Lifestyle Factors and Surgery

Lifestyle factors can have an impact on the functional results of some elective surgery.  In particular, smoking is well known to affect the outcomes of some foot and ankle procedures.  In addition, many studies have shown that the rates of postoperative complications and length of stay are higher in patients who are overweight or who smoke.

Therefore, to ensure optimal outcomes, all patients who smoke or have a body mass index of 35 or greater and are being considered for referral to Secondary Care, should be able to access CCG and Local Authority Public Health commissioned smoking cessation and weight reduction management services prior to surgery.

Patient engagement with these ‘preventive services’ may influence the immediate outcome of surgery.  While failure to quit smoking, or lose weight will not be a contraindication for surgery, GPs and Surgeons should ensure patients are fully informed of the risks associated with the procedure in the context of their lifestyle. 

Psychological Factors and Surgery

Commissioners acknowledge that there is a psychological dimension for patients in seeking or considering the option of treatment and surgery. However because there are no universally accepted and objective measures of psychological distress and therefore such factors are not taken in account in any policy clinical thresholds. Nevertheless there always remains the option of an application to demonstrate clinical exceptionality through IFR process as detailed above.

Other Existing Local CCG Policies

The following treatment policies are currently in development:

Treatment Policy Category Treatment Policy Detail Patient Treatment Decision Aid
Assisted Conception Restricted             Assisted conception   
Bariatric Surgery Restricted              Bariatric Surgery   
Carpal Tunnel Restricted              Carpal Tunnel  pdfCarpal Tunnel Syndrome (76 KB)
Community Equipment and Wheelchairs   Community Equipment and Wheelchairs  
Complementary therapies and alternative medicines Not routinely commissioned Complementary therapies and alternative medicines   
Diagnostic Arthroscopy of the Knee Joint Not routinely commissioned Diagnostic Arthroscopy of the Knee Joint   
Facet joint and epidural injections Restricted              Facet joint and epidural injections   
Port Wine Stain Not routinely commissioned    
Rosecea – Laser Treatment Not routinely commissioned    
Planned caesarean section Restricted- RCOG Guidelines    pdfBirth options after previous C-Section (73 KB)
Laser treatment for myopia (keratoplasty) Not routinely commissioned    
Dupuytren Contracture   Dupuytren Contracture   
Reversal of male and female sterilisation (including vasectomies) Not routinely commissioned    
Any treatment purporting to treat allergy as a cause of chronic (post-viral) fatigue syndrome Not routinely commissioned    
Treatment of myalgic encephalomyelitis Not routinely commissioned    
Any treatment of candida hypersensitivity syndrome Not routinely commissioned    
Radiotherapy for age-related macular degeneration of the eye Not routinely commissioned    
Nucleoplasty (percutaneous coblation disc herniation) Not routinely commissioned    
Arthroscopic washout Not routinely commissioned    
Use of dilators or microwaves for benign prostatic hyperplasia Not routinely commissioned    
Use of lithiotripsy to treat small asymptomatic renal calculi Not routinely commissioned    
Congenital vascular abnormalities Restricted    
Photodynamic therapy Restricted    
Surgical removal of mucoid cysts at DIP joint Restricted    
NIV & CPAP Machine Restricted    
Hyperbaric Oxygen Therapy Restricted    
Removal of ear wax Restricted (established primary  care pathway in Solihull)    
Allergy Testing Restricted    
Acupuncture Restricted    
Carotid artery surgery for asymptomatic patients with carotid artery disease Restricted    
Botulinum toxin for facial ageing Not routinely commissioned    
Non-emergency patient transport Restricted  pdfNEPT - Patient Charter and Eligibility Criteria(757 KB)

 pdfNEPT on a page(598 KB)

Dilation of Cervix   Dilation of Cervix Uteri Curettage of Uterus   

New treatment policies in development

Coming soon.

Supporting Patients and Clinicians in Shared Decision Making

View the Supporting Patients and Clinicians in Shared Decision Making webpage here.