Treatment List

EIA completed and approved by PEC June 2009.
Category A - Treatments Not Commissioned Category B - Treatments Commissioned on an Individual Basis Category C - Procedures in this category should only be done if patients meet certain criteria and a 10% sample of all patients will be audited each year to check compliance Compliance with locally agreed Map of Medicine pathways is expected and will be audited Drugs and treatments that are the subject of a NICE Technology Appraisal (TA) in which their use is approved will be funded by NHS Stockport within 3 months of the issue date of the NICE TA for patients who meet the criteria stipulated in the TA. Drugs and treatments that are the subject of a NICE Technology Appraisal (TA) in which their use is NOT approved will NOT be funded. These drugs and treatments are not included in this treatment list. NHS Stockport's commissioning position in relation to NICE Interventional Procedure Guidance (IPG) is contained in a separate document: NHS Stockport commissioning position for NICE IPG . K:\Treatment list and connected policy statements\NHS Stockport commissioning position for NICE IPG.xls
Specialty
Procedure
Prior approval Category Commissioning Positition form available Prior approval EUR team Group approval Prior approval EUR team No This treatment is commissioned on an individual patient basis
Policy Statement
Equality and Diversity checked
Haematology
Betaine for homocystinuria Botulinum Toxin Cervical Dystonia Botulinum toxin for spasticity in adults
NHS Stockport Local Policy Statement No. 187 NHS Stockport Local Policy Statement No. 10 GM Evidence Review No.16
Jun-09
Neurology
N/A
Treatment of cervical dystonia with botulinum toxin is safe and effective. Stockport PCT commissions treatment via Hope Hospital, Salford.
Jun-09
Neurology
No
Approved on an individual basis according to certain criteria Approval according to certain criteria BTA injections are not suitable for all children with cerebral palsy and patient selection is very important. Availability and commissioning of support services should be considered prior to approval of treatment with BTA. This treatment is not commissioned as there is insufficient published evidence of its clinical effectiveness
Jun-09
Neurology
Prior Botulinum Toxin A for approval spasticity in children EUR team Naltrexone for Multiple Not Sclerosis supported
No
GM Evidence Review No. 8 NHS Stockport Local Policy Statement No. 46
Jun-09
Neurology
N/A
Jun-09
Neurology
Sativex
Not supported
N/A
This treatment is not commissioned for neuropathic pain as there is NHS Stockport limited published evidence of its clinical effectiveness. NHS Stockport Local Policy does not commission Sativex for symptomatic treatment in patients with Statement No. 43 moderate to severe spasticity due to Multiple Sclerosis Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10 Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10
Jun-09
Oncology
Aprepitant
Prior approval EUR team
No
Approved for use as an anti-emetic 2nd line after 5HT3.
Jun-09
Oncology
Capecitabine
Not supported
N/A
This is not commissioned as treatment in advanced pancreatic cancer.
Jun-09
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A
Policy Statement
Oncology
Dasatinib
Pre-NICE Cancer This is not commissioned for Acute Lymphoblastic Leukaemia (ALL) drugs resistant to or intolerant of Imatinib. recommendations to commissioners Pre-NICE Cancer drugs Approved for use in head and neck cancers in combination with Cisplatin recommendations and 5-FU in patients with a good performance status. to commissioners across NWSHA 2009/10 Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10 Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10
Jun-09
Oncology
Docetaxel
No
Jun-09
Oncology
Gefitinib
Not supported
N/A
This is not commissioned for 2nd line or subsequent treatment of nonsmall cell lung cancer.
Jun-09
Oncology
Gemcitabine & Cisplatin
Not supported
N/A
This is not commissioned for cholangio cancers
Jun-09
Oncology
Ibritumumab
Not supported
N/A
Pre-NICE Cancer drugs This is not commissioned for consolidation therapy after induction in recommendations follicular lymphoma. to commissioners across NWSHA 2009/10
Jun-09
Specialty
Procedure
Prior approval Category Commissioning Positition form available
Policy Statement
Oncology
Ixabepilone
Not supported
N/A
This is not commissioned for metastatic breast cancer.
Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10
Jun-09
Oncology
Lapatinib
Not supported
N/A
Pre-NICE Cancer drugs This is not commissioned for metastatic HER2 positive breast carcinoma recommendations after Herceptin. to commissioners across NWSHA 2009/10 Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10
Jun-09
Oncology
LMWH for DVT prevention in cancer patients.
Not supported
N/A
This is not commissioned.
Jun-09
Oncology
Nilotinib
Not supported
N/A
Pre-NICE Cancer drugs This is not commissioned for Acute Lymphoblastic Leukaemia (ALL) recommendations resistant to or intolerant of Imatinib. to commissioners across NWSHA 2009/10 Pre-NICE Cancer Approved for aspergillosis following acute leukaemia and BMT when other drugs antifungal agents have failed and where treatment is given under recommendations specialist advice from a clinician familiar with the treatment of to commissioners aspergillosis. across NWSHA 2009/10
Jun-09
Oncology
Posaconazole
No
Jun-09
Specialty
Procedure
Policy Statement
Oncology
Sorafenib
No
Pre-NICE Cancer drugs This is not commissioned for metastatic hepatocellular carcinoma with the recommendations exception of recurrence in a transplanted liver with otherwise normal to commissioners function. across NWSHA 2009/10 Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10
Jun-09
Oncology
Tropotecan (oral)
Not supported
N/A
This is not commissioned for small call lung carcinoma.
Jun-09
Specialty
Procedure
Policy Statement
Ophthalmology
Anti VEGF for wet AMD
No
The treatment of wet age-related macular degeneration (AMD) with antiVEGF is covered by NICE TA155: Ranibizumab and Pegaptanib for the treatment of age-related macular degeneration. In this guidance Pegaptanib (Macugen) is not recommended for use in wet AMD. Ranibizumab (Lucentis) is recommended for individuals with wet AMD when the following criteria are met: The best possible visual acuity after correction with glasses or contact lenses is between 6/12 and 6/96; and There is no permanent damage to the fovea (the part of the eye that helps people to see things in sharp detail); and The area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina; and There are signs that the condition has been getting worse. A third anti VEGF, Bevacizumab (Avastin) was not considered by NICE as this drug is not licensed for use in wet AMD. NHS Stockport offers patients who meet the criteria listed above a choice of treatment with either Lucentis or Avastin. Treatment with Avastin is NHS Stockport delivered through an NHS contract with the Alexandra Hospital, Cheadle. Local Policy Treatment with Lucentis is delivered by an NHS provider, currently this is Statement No. 51 Manchester Eye Hospital. When a patient has been receiving treatment with Avastin at the Alexandra Hospital and develops a complication necessitating a change to Lucentis the patient may continue to receive care at the Alexandra Hospital. When a patient has been receiving treatment with Avastin at the Alexandra Hospital and wishes to change to Lucentis, either because the Avastin is not controlling the wet AMD sufficiently or through personal preference, the care of the patient will be transferred to an NHS provider. When a patient has been receiving an anti-VEGF privately, providing they meet the NICE criteria for treatment with an anti-VEGF, they may switch to NHS care. If the patient has been treated with Avastin and they are happy to continue they will be treated with Avastin at the Alexandra Hospital. If a patient has been treated privately with Lucentis or wishes to switch from Avastin to Lucentis on swapping from private to NHS care their care will be provided by an NHS provider.
Specialty
Procedure Infliximab for uveitis secondary to idiopathic juvenile arthritis
Prior approval Category Commissioning Positition form available Not supported N/A This treatment is not commissioned
Policy Statement
Ophthalmology
NHS Stockport Local Policy Statement No. 37 NHS Stockport Local Policy Statement No. 41
Jun-09
Ophthalmology
Rituximab for MAR Prior (melanoma associated approval retinopathy) EUR team Azoles for invasive aspergillosis Prior approval EUR team
No
This is commissioned on an individual patient basis
Jun-09
Respiratory
No
Posaconazole & Voriconazole are approved for the treatment and NHS Stockport prevention of aspergillosis when used in line with the treatment protocols Local Policy available from the University Hospital of South Manchester NHS Statement No. 34 Foundation Trust. Only patients who do not respond to sildenafil should be considered for treatment with an endothelian receptor antagonist (bosentan) or a prostacyclin (epoprostenol treprostinil). As all these drugs have been shown to have some degree of effectiveness but have not been directly compared, the choice of drug should therefore be based on whichever is least expensive. This herbal medicine is not commissioned as it is not licensed and there is evidence that it is not effective. This is not commissioned as there is limited published evidence of effectiveness This is not commissioned as there is limited published evidence of effectiveness Greater Manchester Evidence Review No.6
Jun-09
Respiratory
Drugs for Primary Pulmonary (arterial) Hypertension
No
Jun-09
Urology
Saw Palmetto (Prostasan) Mistletoe therapy (Iscador) Pregabalin for Generalised Anxiety Disorder (GAD)
Not supported Not supported Not supported
N/A
NHS Stockport Local Policy Statement No. 188 NHS Stockport Local Policy Statement No. 56 NHS Stockport Local Policy Statement No. 189
Jun-09
Oncology
N/A
Sep-09
Psychiatry
N/A
Sep-09
Respiratory
Azoles for Allergic Bronchopulmonary Not Apsergillosis and supported fungal sensitisation in asthma
N/A
Posaconazole and voriconazole are not commissioned for the treatment of NHS Stockport Allergic Bronchopulmonary Aspergillosis or for fungal sensitisation in Local Policy asthma as there is limited published evidence of their effectiveness in Statement No. 58 these conditions. An evidence review is attached
Sep-09
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported Group approval N/A This is not commissioned as there is limited published evidence of effectiveness
Policy Statement
Rheumatology
Rituximab for SLE GM HCV strategy treatment guidelines for hep C
NHS Stockport Local Policy Statement No. 190 NHS Stockport Local Policy Statement No. 59 NHS Stockport Local Policy Statement No. 191
Sep-09
Hepatology
N/A
This is commissioned in line with the GMMMG recommendation This is not commissioned as there is little published evidence to support the use of fluconazole in the management of ductal candidiasis in breastfeeding women.
Sep-09
General Practice
Fluconazole for thrush Not in breastfeeding supported
N/A
Feb-10
Haematology
Siklos for Sickle Cell Crisis
Not supported
N/A
In 2009 Nordic licensed Siklos (a form of hydroxycarbamide) for Sickle Cell Crisis. Hydroxycarbamide has been available on the NHS as a NHS Stockport Local Policy licensed drug for a number of years, but neither of the two existing products are specifically licensed for Sickle Cell Crisis. Siklos will be on Statement No. 61 average 10 times the cost of the current hydroxycarbamide products. As a result only generic versions of hydroxycarbamide will be funded. Therapies included in this section are considered LOW PRIORITY. Included in this section is: Acupuncture, Alexander Technique, Applied Kinesiology, Aromatherapy, Autogenic Training, Ayurveda, Chiropractic, NHS Stockport Environmental Medicine, Osteopathy, Healing, Herbal Medicine, Hypnosis, Local Policy Homeopathy, Massage, Meditation, Naturopathy, Nutritional Therapy, Statement No. 8 Reflexology, Reiki, Shiatsu, Other alternative therapies. Complementary medicine/alternative therapies are not funded as stand alone services. Acupuncture is available within some musculoskeletal care pathways. Ellaone is recommended as a treatment option for those patients that NHS Stockport present between 72 and 120 hours of unprotected sexual intercourse or Local Policy contraceptive failure. Levonelle (levonorgestrel) remains the first choice Statement No. 192 for those patients that present for emergency contraception 0 to 72 hours of unprotected sexual intercourse or contraceptive failure Rupatadine may be considered as a third line treatment option for allergic NHS Stockport rhinitis after the use of more established cost effective therapies (e.g. Local Policy cetirizine, loratadine) and as a second or third line treatment option in Statement No. 193 resistant CIU.
Sep-09
Alternative / Complementary therapies
Not supported
N/A
Feb-10
Family Planning
Ulipristal (EllaOne )
Group approval
N/A
Nov-09
General Practice
Rupatadine (Rupafin)
Group approval
N/A
Nov-09
Specialty
Pain management
Oncology
Prior approval Equality and Diversity Procedure Category Commissioning Positition Policy Statement form checked available Targinact is not recommended for routine prescribing as it has not NHS Stockport demonstrated sufficient clinical or cost effectiveness. The clinical benefit Oxycodone/Naloxone Not N/A Local Policy Nov-09 of this preparation in patients already receiving regular laxative therapy is MR (Targinact) supported Statement No. 194 uncertain Radiolabelled basiliximab for the treatment of refractory lymphoma is not NHS Stockport Radiolabelled Not commissioned by NHS Stockport owing to the lack of published evidence basiliximab for N/A Local Policy Mar-10 supported of effectiveness. refractory lymphoma Statement No. 70 Cetuximab for wild type K-ras metastatic colorectal cancer is not commissioned by NHS Stockport. Cetuximab, as part of first-line treatment of certain patients with metastatic colorectal cancer is routinely funded, in accordance with NICE 176. However, the drug is not routinely funded for the second-line or subsequent treatment of metastatic colorectal cancer after the failure of an irinotecan containing chemotherapy regimen, in line with NICE TA 118. This latter appraisal did not consider K-ras status as a means of identifying patients who are unlikely to respond to treatment. A review by The School of Health and Related Research (ScHARR) University of Sheffield for Yorkshire and the Humber Specialised Commissioning Group concluded that the use of cetuximab as 3rd-line treatment of metastatic colorectal cancer in patient with wild type K-ras tumours was not considered to be cost-effective.
Oncology
Cetuximab for wild Not type K-ras metastatic supported colorectal cancer
N/A
NHS Stockport Local Policy Statement No. 73
May-10
Neurology
Botulinum toxin injections for Prior sialorrhoea (excessive approval salivation) secondary EUR team to upper motor neuron lesions in adults Oral posaconazole, long term Ambisome, IV Gamma Interferon, Not IV Micafugin for supported chronic pulmonary aspergillosis
Yes
NHS Stockport Local Policy NHS Stockport commissions botulinum toxin injections for sialorrhoea (excessive salivation) secondary to upper motor neuron lesions in adults Statement No. 77 on a named patient basis where other methods have failed to control the condition and where there is a high risk of aspiration.
May-10
Respiratory
N/A
NHS Stockport does not commission the following for the treatment of Chronic Pulmonary Aspergillosis: Oral Posaconazole, Long term Ambisome as an outpatient, IV Gamma Interferon, IV Micafungin.
May-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported Prior approval EUR team Not supported N/A
Policy Statement
Oncology
Alemtuzumab
GM Cancer Drugs This is not commissioned for patients with relapsed / refractory cutaneous Recommendation T-cell lymphoma 2010/2011 This is commissioned for patients with chronic lymphocytic leukaemia (CLL) with the 17-q abnormality GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Alemtuzumab
Yes
Sep-10
Oncology
Arsenic
N/A
This is not commissioned for acute promyelocytic leukaemia
Sep-10
Oncology
Bendamustine
Not supported
N/A
This is not commissioned for first line non-Hodgkins lymphoma (NHL) including mantle cell lymphomas (MCL) in combination with rituximab
Sep-10
Oncology
Bevacizumab
Not supported
N/A
This is not commissioned as a first line treatment for breast cancer
Sep-10
Oncology
Bevacizumab
Not supported
N/A
This is not commissioned for glioblastoma
Sep-10
Oncology
Bevacizumab
Not supported
N/A
GM Cancer Drugs This is not commissioned as a first line treatment for advanced/metastatic Recommendation ovarian cancer 2010/2011 This is not commissioned second or third line for mantel cell lymphoma (MCL) GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Bortezomib
Not supported
N/A
Sep-10
Oncology
Bortezomib
Not supported
N/A
GM Cancer Drugs This is not commissioned for relapsed Waldenstroms macroglobulinaemia Recommendation 2010/2011
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A This is not commissioned for Duke's C colorectal cancer in combination with oxaplatin based chemotherapy
Policy Statement
Oncology
Capecitabine
GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Cetuximab
Not supported
N/A
This is not commissioned for advanced non small cell lung cancer (NSCLC)
Sep-10
Oncology
Cisplatin
Not supported
N/A
This is not commissioned for ovarian peritoneal carcinomatosis
Sep-10
Oncology
Clofarabine
Not supported
N/A
This is not commissioned for first line treatment of Acute Myeloid GM Cancer Drugs Leukaemia (AML) in patients >=65 years of age who have one or more of: Recommendation adverse cytogenetics, secondary AML, age >= 70 years, significant 2010/2011 comorbidities, are not considered suitable for intensive chemotherapy. This is not commissioned Chronic Myeloid Leukaemia (CML) blast crisis either first line nor following imatinib failure / intolerance GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Dasitinib
Not supported
N/A
Sep-10
Oncology
Decitabine
Not supported Prior approval EUR team Prior approval EUR team
N/A
This is not commissioned for myelodysplastic syndrome
Sep-10
Oncology
Degarelix
No
This is commissioned for advanced hormone dependant prostate cancer only when LHRH analogues or concommitant anti-andrgoens are contraindicated This is commissioned for patients with metastatic prostate cancer who demonstrated a response to first line therapy
Sep-10
Oncology
Docetaxel
No
Sep-10
Oncology
Docetaxel, carboplatin, Not trastuzumab (TCH) supported regimen
N/A
This is not commissioned for breast cancer
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available N/A This is not commissioned for chemo embolisation in hepatocellular carcinoma (HCC)
Policy Statement
Oncology
Doxorubicin with microNot beads supported
GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Erlotinib
Not supported
N/A
This is not commissioned as maintenance therapy in non small cell lung cancer (NSCLC) This is not commissioned for the treatment of advanced and / or metastatic renal cell carcinoma (RCC) in patients whose disease has progressed on VEGF targeted therapy such as sunitinib
Sep-10
Oncology
Everolimus
Not supported
N/A
Sep-10
Oncology
Everolimus
Not supported Prior approval EUR team Not supported
N/A
This is not commissioned for pancreatic neuroendocrine tumours
Sep-10
Oncology
Gemtuzumab Ozogomycin
Yes
The excess treatment costs of the National NRCN trial of induction for Acute Myeloid Leukaemia (AML) will be funded
Sep-10
Oncology
N/A
This is not commissioned for single agent use in relapsed Acute Myeloid Leukaemia (AML)
Sep-10
Oncology
Not supported
N/A
This is not commissioned for patients aged >60 years of age for reinduction of Acute Myeloid Leukaemia (AML) in relapsed disease
Sep-10
Oncology
Not supported
N/A
This is not commissioned for induction or reinduction of Acute Myeloid Leukaemia (AML) for those patients ineligible for the trial
Sep-10
Oncology
Histamine dihydrochloride
Not supported
N/A
This is not commissioned as for first remission maintenance therapy in combination with IL-2 for Acute Myeloid Leukaemia (AML)
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A This is not commissioned for stage III and stage IV melanoma
Policy Statement
Oncology
Ipilimumab
GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Irbitumomab
Not supported
N/A
This is not commissioned for relapsed follicular lymphoma
Sep-10
Oncology
Larotaxel
N/A
This is not commissioned for second line advanced/metastatic pancreatic cancer This is commissioned for 2nd line use in multiple myeloma in patients unable to tolerate bortezomib or futher thalidomide/vincristine due to neuropathy. This is not commissioned for Chronic Lymphocytic Leukaemia (CLL) refractory to chemotherapy and immunotherapy for those who have failed fludarabine and/or alemtuzumab or for whom these are unsuitable/not tolerated This is not commissioned for myelodysplastic syndrome (MDS) 5q
Sep-10
Oncology
Lenalidomide
Yes
Sep-10
Oncology
Lenalidomide
N/A
Sep-10
Oncology
Lenalidomide
Not supported Prior approval EUR team Not supported Prior approval EUR team
N/A
Sep-10
Oncology
Myocet
No
This is commissioned for metastatic breast cancer in patients who have previously had the FEC-T regime and relapsed and would benefit from further anthracycline therapy but cardiac toxicity precludes its use. This is not commissioned as third line treatment of Gastrointestinal Stromal Tumour (GIST) that is advanced, unresectable and/or metastatic and resistant to both imatinib and sunitinib This is commissioned instead of 100mg/m2 docetaxel as per the Christie Hospital protocol for metastatic breast cancer
Sep-10
Oncology
Nilotinib
N/A
Sep-10
Oncology
Paclitaxel, albumin bound
No
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A
Policy Statement
Oncology
Pazopanib
GM Cancer Drugs This is not commissioned for the second line treatment of metastatic renal Recommendation cancer 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Peg-interferon
Not supported
N/A
This is not commissioned for stage III malignant melanoma
Sep-10
Oncology
Picoplatin
Not supported
N/A
This is not commissioned for second line treatment of platinum refractory or resistant small cell lung cancer This is not commissioned for third line treatment of relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) which has failed at least two other combination chemotherapy regimens
Sep-10
Oncology
Pixantrone
Not supported
N/A
Sep-10
Oncology
Rituximab
Not supported
N/A
This is not commissioned for Waldenstroms Macroglobulinaemia
Sep-10
Oncology
Sorafenib
Not supported
N/A
This is not commissioned for first line treatment of non small cell lung cancer (NSCLC)
Sep-10
Oncology
Sunitinib
Not supported
N/A
This is not commissioned for pancreatic cancer
Sep-10
Oncology
Sunitinib
Not supported
N/A
GM Cancer Drugs This is not commissioned for metastatic breast carcinoma for patients who Recommendation have received prior treatment with an anthracycline and a taxane 2010/2011 This is not commissioned as first line treatment in combination with docetaxel for patients with unresectable locally recurrent or metastatic breast cancer GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Sunitinib
Not supported
N/A
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A This is not commissioned for unresectable metastatic melanoma
Policy Statement
Oncology
Temozolomide
GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011 GM Cancer Drugs Recommendation 2010/2011
Sep-10
Oncology
Temozolomide
Not supported
N/A
This is not commissioned for extended (longer than 6 months) treatment for high grade gliomas
Sep-10
Oncology
Temozolomide
Not supported
N/A
This is not commissioned for low grade gliomas
Sep-10
Oncology
Tolvaptan
Not supported
N/A
This is not commissioned for hyponatraemia secondary to SIADH (syndrome of inappropriate antidiuretic hormone hypersecretion)
Sep-10
Oncology
Vandetanib
Not supported
N/A
This is not commissioned as second line treatment for non small cell lung cancer (NSCLC)
Sep-10
Oncology
Vinflunine
Not supported
N/A
This is not commissioned as second line treatment of advanced or GM Cancer Drugs metastatic transitional cell carcinoma of the urothelial tract after failure of a Recommendation prior platinum containing regimen 2010/2011 This is not commissioned for consolidation after induction therapy for follicular lymphoma This is not commissioned for first line adjuvant treatment (in combination with oestrogen blockade and standard endocrine therapy) of premenopausal stage I or II hormone-responsive breast cancer. Sildenafil for pulmonary hypertension out of proportion to COPD is not commissioned by NHS Stockport. GM Cancer Drugs Recommendation 2010/2012 GM Cancer Drugs Recommendation 2010/2011 NHS Stockport Local Policy Statement No. 80
Sep-10
Oncology
Zevalin
Not supported
N/A
Sep-10
Oncology
Zoledronic acid (Zometa) Sildenafil for pulmonary hypertension out of proportion to COPD
Not supported
N/A
Sep-10
Respiratory
Not supported
N/A
Sep-10
Specialty
Procedure
Prior approval Category Commissioning Positition form available N/A Mycophenolate for interstitial lung disease is not commissioned by NHS Stockport.
Policy Statement NHS Stockport Local Policy Statement No. 81
Respiratory
Mycophenolate for Not interstitial lung disease supported Prior Rituximab for chronic approval ITP in adults EUR team
Sep-10
Haematology
Yes
NHS Stockport Rituximab for chronic idiopathic thrombocytopenic purpura Local Policy is commissioned by NHS Stockport for adult patients with a platelet count Statement No. 83 <10,000 per L of blood who have failed to respond to standard treatment.
Sep-10
Urology
Erectile dysfunction
Group approval
N/A
No more than four treatments (not tablets) per four weeks are prescribable. Tadalafil Once Daily may not be prescribed. Drug treatments for erectile dysfunction should only be prescribed by General Practitioners for patients who:have a chronic disease associated with erectile dysfunction e.g. diabetes, multiple sclerosis, Parkinsons disease, poliomyelitis, prostate cancer, severe pelvic injury, spina bifida and spinal cord injury; and / orare receiving dialysis for renal failure; and / orhave had radical pelvic surgery, prostatectomy or kidney transplant; orwere previously receiving Caverject, Erecnos, MUSE, Viagra, or Viridal for erectile dysfunction at the expense of the NHS on the 14th September 1998.Erectile dysfunction may be a side-effect of some drug treatments NHS Stockport for chronic conditions where possible the drug should be changed to one Local Policy which has less effect on erectile function. Drug treatments for erectile Statement No 33 dysfunction may be prescribed where a drug switich is not possible and where counteracting or surgery will be made by the surgeon after discussion with the patient.gime of antipsychotics.This also applies to vacuum pumps and constrictor rings for the treatment of erectile dysfunction. Penile prosthesis will be funded: as part of reconstructive treatment following surgery of the treatment of malignant or other diseases as part of reconstructive surgery following trauma and all nonsurgical methods of treatment must previously have been exhausted. Penile Prosthesis will not be funded for cosmetic reasons. Patients with erectile dysfunction may make use of any NHS psychological and psychosexual counselling services that are available within the portfolio of service agreements.
Sep-10
Specialty
Allergy
Neurology
Neurology
Neurology
Prior approval Procedure Category Commissioning Positition form available This treatment is not commissioned in line with the recommendation from the Greater Manchester Medicines Management Group New Therapies Not Subgroup (GMMMG NTS). The group does not recommend Grazax for Grazax N/A supported the treatment of grass pollen induced hayfever in adult patients with clinically relevant symptoms and a positive skin prick test or specific IgE test to grass pollen. This is not commissioned, in line with GMMMG guidance: Co-Careldopa Duodopa for advanced Not (Duodopa) intestinal gel for the treatment for advanced Parkinsons N/A Parkinson's disease supported disease . April 2010. Based on NHS Bolton's Commissioning Policy Number 6: Beta interferon, glatiramer acetate, natalizumab, mitoxantrone and azathioprine for the Prior management of multiple sclerosis. High cost MS Drugs approval Yes NHS Stockport commissions beta interferon, glatiramer acetate, EUR team natalizumab, mitoxantrone and azathioprine for the managament of multiple sclerosis when certain criteria are met This treatment is not commissioned, in line with GMMMG guidance: Sodium oxybate for Not Sodium Oxybate (Xyrem ) for the treatment of cataplexy in adult narcolepsy with N/A supported patients with narcolepsy . April 2010 cataplexy Abstral Group approval Group approval Not supported Not supported N/A
Policy Statement
NHS Stockport Local Policy Statement No.38 NHS Stockport Local Policy Statement No.57 NHS Stockport Local Policy Statement No. 88
Nov-10
Sep-10
Sep-10
Oncology
Oncology
Effentora Vitamin B12 for CFS/ME
N/A
Neurology
N/A
NHS Stockport Local Policy Statement No. 42 NHS Stockport Abstral may be prescribed on an individual patient basis for incident or Local Policy short burst pain by the Specialist Palliative Team only. Statement No. 89 NHS Stockport Effentora may be presccribed on an individual patient basis for incident or Local Policy short burst pain by the Specialist Palliative Team only. Statement No. 89 NHS Stockport NHS Stockport doesnt commission Vitamin B12 for the treatment of Local Policy chronic fatigue syndrome due to insufficient evidence of effectiveness. Statement No. 97 NHS Stockport NHS Stockport does not Erfa / Armour thyroid owing to insufficient Local Policy evidence of effectiveness over standard treatment with synthetic Statement No. 101 thyroxine. NHS Stockport does not commission rasagiline for early or advanced NHS Stockport Parkinson's Diseaseas as the long-term safety and its relative efficacy Local Policy compared with other drugs for Parkinsons disease have not been Statement No. 195 examined and its role in treatment can not be currently defined.
Sep-10
Nov-10
Nov-10
Nov-10
General Practice
Erfa / Armour thyroid
N/A
Nov-10
Neurology
Rasagiline
Not supported
N/A
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A NHS Stockport doesnt commission Vitamin B12 for the treatment of multiple sclerosis due to insufficient evidence of effectiveness.
Policy Statement
Neurology
Vitamin B12 for MS
Nov-10
Rheumatology
Teriparatide for the secondary prevention of fragility fractures in osteopenia where Not there is inadequate supported response to or intolerance of bisphosphonates anti VEGF for retinal vein occlusion Not supported
N/A
NHS Stockport does not commission teriparatide for the secondary prevention of fragility fractures in osteopenia where there is inadequate response to or intolerance of bisphosphonates owing to insufficient evidence of effectiveness
Ophthalmology
N/A
NHS Stockport does not commission anti VEGF for retinal vein occlusion as their use in this condition is considered experimental.
Rheumatology
Lodotra
Not supported
N/A
In line with the GMMMG NTS guidance issued in February 2011 NHS Stockport does not commission the use of Prednisolone Modified Release NHS Stockport Tablet (Lodotra ) for the treatment of moderate to severe, active Local Policy rheumatoid arthritis because of insufficient evidence of cost effectiveness Statement No. 118 over available alternatives GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2010/2011
Oncology
Abraxane
Not supported
N/A
This is not commissioned for the treatment of metastatic breast cancer
Oncology
Afatinib
Not supported
N/A
This is not commissioned for the treatment of non small cell lung cancer (NSCLC)
Oncology
Bendamustine
Not supported
N/A
This is not commissioned for indolent non-Hodgkin's lymphoma (NHL)
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A This is not commissioned for the treatment of relapsed/refractory ALL in patients <21 years of age
Policy Statement
Oncology
Clofarabine
GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012
Oncology
Crizotinib
Not supported
N/A
This is not commissioned for the second line treatment of non small cell lung cancer (NSCLC)
Oncology
Nelarabine
Not supported
N/A
This is not commissioned for the treatment of relapsed/refractory T-ALL / T-LBL
Oncology
Oxaliplatin
N/A
GM Cancer Drugs This is not commissioned for the treatment of peritoneal carcinomatosis of Recommendation the colorectal region 2011/2012 This is commissioned for FEC100/FEC-T prophylaxis in early breast cancer GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012 GM Cancer Drugs Recommendation 2011/2012
Oncology
Pegfilgrastim
No
Oncology
Rituximab
N/A
This is not commissioned for maintenance treatment for follicular nonHodgkins lymphoma
Oncology
Sorafenib
Not supported
N/A
This is not commissioned for the treatment of metastatic thyroid cancer
Oncology
TCH (Taxotere (docetaxel), Not Carboplatin, Herceptin supported (trastuzumab) Not supported
N/A
This is not commissioned for the adjuvant treatment of HER2+ve breast cancer
Oncology
Trabectedin
N/A
This is not commissioned for the treatment of relapsed ovarian cancer
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported Prior approval EUR team Prior approval EUR team N/A This is not commissioned for the treatment of metastatic thyroid cancer
Policy Statement
Oncology
Vandetanib
GM Cancer Drugs Recommendation 2011/2012 NHS Stockport Local Policy Statement No. 196
Obstetrics & Gynaecology
Nuvaring
No
This contraceptive is commissioned on a prior approval basis
Oncology
Retreatment with bortezomib for AL amyloidosis 3,4 diaminopyridine (phosphate form) Firdapse when generic supplies run out
No
NHS Stockport commissions retreatment with bortezomib (Velcade ) for NHS Stockport AL amyloidosis for patients who had a good response to the previous Local Policy treatment with bortezomib and would have a good quality of life if the Statement No. 122 amyloidosis was in remission NHS Stockport commissions the unlicensed DAP (base from) for LambertEaton myasthenic syndrome and congenital myasthenic syndromes. NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Where there is a problem with supply of the DAP (base form) Firdapse may be substituted for patients gaining benefit from the DAP (base form) Statement No. 112 not discriminatory. and for whom no other alternative treatment regimen will offer adequate benefit and where generic supplies have ran out. NHS Stockport only commissions treatment for fungal nail infections if the following criteria are met: the patient is immunocompromised; or the patient has peripheral vascular disease; or the patient is diabetic; or the nail is painful; or the patient is due to undergo surgery on that limb; AND NHS Stockport Local Policy there has been mycological confirmation. When Terbinafine is the drug of choice only oral terbinafine should be prescribed as topical terbinafine has Statement No. 92 inferior efficacy. Prescribers should ensure that they follow the British National Formulary (BNF) guidelines for monitoring patients and that patients do not continue treatment for longer than the recommended duration as outlined in The BNF. NHS Stockport Mar 2012 - The Group Whilst there is evidence of the effectiveness of treatment, including Local Policy felt that this policy was surgery and botulinum toxin injections, for hyperhidrosis, treatment of this Statement No. 31 not discriminatory. condition is considered LOW PRIORITY and hence not commissioned.
Neurology
N/a
General Practice Fungal nail infeactions
Group approval
N/A
General Practice
Hyperhidrosis
Not supported
N/A
Specialty
Procedure
Oncology
Cetuximab in nonmetastasised colorectal cancer Dexamethasone implant (Ozurdex ) for Diabetic Macular Oedema (DMO)
Prior approval Category Commissioning Positition Policy Statement form available NHS Stockport commissions 3 months of cetuximab in wild-type KRAS colorectal cancer where the patient does not have any metastases, where Prior NHS Stockport the primary tumour needs to be reduced in size prior to surgery and where approval No Local Policy reducing the tumour size prior to surgery has the potential for the surgery Statement No. 127 EUR team to be a curative treatment Not supported N/A NHS Stockport does not commission the use of dexamethasone implant for Diabetic Macular Oedema owing to insufficient evidence of effectiveness
Mar 2012 - The Group felt that this policy was not discriminatory.
Ophthalmology
NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement No.128 not discriminatory.
Cardiology
Aliskiren
Group approval
N/A
Cardiology
Eplerenone
Group approval
N/A
Specialist initiation only. In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of aliskiren (Rasilez) for the treatment of hypertension only when recommended by a specialist for NHS Stockport Local Policy those high risk patients who are poorly controlled or cannot tolerate conventional antihypertensive agents i.e. used as a fourth line or Statement No.145 subsequent antihypertensive drug after use or consideration of alphaadrenoceptor blocking drugs (e.g. doxazosin), potassium-sparing diuretics and aldosterone antagonists (e.g. spironolactone) In line with the GMMMG NTS guidance issued in January 2011 NHS Stockport commissions the use of eplerenone (Inspra) in addition to NHS Stockport standard therapy (including beta-blockers) to reduce the risk of Local Policy cardiovascular mortality and morbidity in stable patients with LVSD (LVEF Statement No.133 < or = 40%) and clinical evidence of heart failure after recent (in the last 14 days) myocardial infarction.
Cardiology
Ivabradine
Group approval
N/A
In line with the GMMMG NTS guidance issued in March 2011 NHS Stockport commissions the use of ivabradine (Procoralan ) for use in chronic, systolic heart failure in patients in sinus rhythm for those patients NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was who fulfill the same criteria as those used in the pivotal trial (i.e. LEVF <35% and a heart rate > 70bpm). This is commissioned when patients Statement No.132 not discriminatory. reach the optimum dose or maximum tolerated doses of betablockers/ACE inhibitors In line with the GMMMG NTS guidance issued in September 2010 NHS NHS Stockport Mar 2012 - The Group Stockport commissions the use of ranolazine (Latixa ) for the treatment Local Policy felt that this policy was of stable angina pectoris only when initiated by a specialist for patients Statement No.142 not discriminatory. who are inadequately controlled on or intolerant of first line antianginal therapies and who are not suitable for surgical intervention.
Cardiology
Ranolazine
Group approval
N/A
Specialty
Procedure
Prior approval Category Commissioning Positition form available Prior approval EUR team
Policy Statement
Endocrinology
Tolvaptan
No
General Practice
Estradiol valerate and dienogest (Qlaira)
Group approval
N/A
Oncology
Methylnaltrexone
Group approval
N/A
Specialist prescribing only.In line with the GMMMG NTS guidance issued NHS Stockport Mar 2012 - The Group in February 2010 NHS Stockport commissions the use of tolvaptan for the Local Policy felt that this policy was treatment of hyponatraemia caused by SIADH for adult patients who have Statement No.129 not discriminatory. frequent hospital admissions and in whom fluid restriction has failed In line with the GMMMG NTS guidance issued in July 2009 NHS Stockport commissions the use of Estradiol valerate and dienogest NHS Stockport Mar 2012 - The Group (Qlaira) combined oral contraceptive pill as a third line treatment option Local Policy felt that this policy was in those patients who cannot tolerate more established and cost effective Statement No.149 not discriminatory. combined oral contraceptives. In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of methylnaltrexone (Relistor) for the NHS Stockport Mar 2012 - The Group treatment of opioid-induced constipation where it is recommended by a Local Policy felt that this policy was palliative care specialist and standard maximal laxative therapy is Statement No.139 not discriminatory. ineffective. Specialist initiation only. In line with the GMMMG NTS guidance issued in NHS Stockport Mar 2012 - The Group July 2011 NHS Stockport commissions the use of lanthanum carbonate Local Policy felt that this policy was (Fosrenol) for the treatment of hyperphosphataemia for patients Statement No.148 not discriminatory. receiving dialysis only after at least one calcium-based phosphate binding agent has been tried including consideration of the use of calcium acetate. Initiation by a Specialist only. In line with the GMMMG NTS guidance NHS Stockport Mar 2012 - The Group issued in June 2011 NHS Stockport commissions the use of lacosamide Local Policy felt that this policy was as a third or fourth line treatment option after more established therapies Statement No.138 not discriminatory. for partial-onset seizures. In line with the GMMMG NTS guidance issued in February 2010 NHS Stockport commissions the use of rivastigmine for the management of NHS Stockport Mar 2012 - The Group dementia with Lewy bodies for those patients who have non-cognitive Local Policy felt that this policy was symptoms causing significant distress to the individual (e.g. hallucinations) Statement No.136 not discriminatory. or leading to challenging behaviour. Specialist initiation only. In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of rotigotine transdermal NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was patches (Neupro) for the treatment of early stage idiopathic Parkinsons disease and in combination with levodopa in the later stages of Statement No.146 not discriminatory. Parkinsons disease for patients in whom oral dopamine agonists are ineffective or for patients with swallowing problems.
Nephrology
Lanthanum carbonate
Group approval
N/A
Neurology
Lacosamide
Group approval
N/A
Neurology
Rivastigmine
Group approval
N/A
Neurology
Rotigotine
Group approval
N/A
Specialty
Procedure
Neurology
Rufinamide
Paediatrics
Risperidone
Respiratory
Micafungin
Rheumatology
Metoject
Prior approval Category Commissioning Positition form available Specialist initiation only. In line with the GMMMG NTS guidance issued in June 2010 NHS Stockport commissions the use of rufinamide in patients Group with Lennox-Gastaut syndrome (LGS), aged four years and older, who N/A approval have failed treatment with or are intolerant of alternative traditional antiepileptic drugs. In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of risperidone for paediatric patients with Group learning difficulties or autism-spectrum disorders provided that use is in N/A approval accordance with the guidance issued by the Child and Adolescent Mental Health Service at Central Manchester & Manchester Childrens University Hospitals NHS Trust. In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport commissions the use of micafungin (Mycamine) for the Group treatment of invasive candidiasis for patients that have failed standard N/A approval antifungal therapy. Micafungin should be used in line with the treatment protocols available from the University Hospital of South Manchester NHS Foundation Trust. Specialist initiation only. In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport commissions the use of Metoject for the Group N/A treatment of moderate to severe rheumatoid arthritis for patients in whom approval parenteral methotrexate is indicated. Group approval
Policy Statement
Urology
Fesoterodine
N/A
In line with the GMMMG NTS guidance issued in June 2011 NHS NHS Stockport Mar 2012 - The Group Stockport commissions the use of fesoterodine for the treatment of Local Policy felt that this policy was symptoms associated with overactive bladder syndrome in patients who Statement No.137 not discriminatory. do not achieve an improvement with immediate release oxybutynin. Prior Approval for initiation in primary care. In line with the GMMMG NTS NHS Stockport guidance issued in March 2011 NHS Stockport commissions the use of Local Policy histrelin subcutaneous implant for the palliative treatment of advanced Statement No.131 prostate cancer in those patients with an anticipated life expectancy of at least one year and in whom annual administration will offer an advantage In line with the GMMMG NTS guidance issued in March 2010 NHS NHS Stockport Stockport commissions the use of indacterol for the treatment of chronic Local Policy obstructive pulmonary disease for patients in whom a long acting Statement no 135 adrenoceptor agonist (LABA) is considered suitable. Mar 2012 - The Group felt that this policy was not discriminatory.
Urology
Histrelin
Group approval
No
Respiratory
Indacterol (OnBrez) for COPD
Group approval
No
Specialty
Procedure
Policy Statement
Psychiatry
Methylphenidate in adults
Group approval
N/A
In line with the GMMMG NTS guidance issued in September 2010 NHS Stockport does not commission the initiation of methylphenidate for NHS Stockport attention-deficit-hyperactivity disorder in adults. Where this condition is Local Policy identified and this treatment is considered appropriate this will be Statement No.144 managed via prior approval through the individual funding request process. Methylphenidate is commissioned for attention-deficithyperactivity disorder in adults as a continuation of adolescent therapy. NHS Stockport does not commission probiotics for ulcerative colitis as although they are as clinically effective as the current standard treatment they are more costly
Mar 2012 - The Group felt that this policy was not discriminatory as patients follow an appropriate pathway
General Practice
Probiotics for ulcerative colitis Rituximab for Wegeners granulomatosis
Not supported Prior approval EUR team
N/A
Rheumatology
Yes
NHS Stockport Mar 2012 - The Group Rituximab is commissioned by NHS Stockport for patients with Wegeners Local Policy felt that this policy was granulomatosis who have failed to respond to all other conventional Statement No. 72 not discriminatory. treatments or in whom the conventional treatments are contraindicated NHS Stockport commissions dexamethasone implant (Ozurdex ) for the NHS Stockport Mar 2012 - The Group treatment of macular oedema resulting from uveitis, on an individual Local Policy felt that this policy was patient basis Statement No. 159 not discriminatory. NHS Stockport does not commission omalizumab for severe chronic urticaria owing to the limited evidence available of this interventions effectiveness and cost effectiveness for this indication NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement No. 158 not discriminatory.
Ophthalmology
Dexamethasone Prior implant (Ozurdex ) approval for macular oedema EUR team resulting from uveitis Omalizumab for severe chronic urticaria Not supported
No
Dermatology
No
Specialty
Procedure
Policy Statement
General Practice
Vitamin D
Not supported
No
Rheumatology
Zoledronic acid for osteoporosis
Group approval
N/A
High dose vitamin D should not be initiated in primary care for patients under the care of Stockport NHS Foundation Trust. High dose vitamin D may be initiated in primary care following a recommendation from a secondary care clinician based in a hospital other than Stepping Hill. Treatment with vitamin D following vitamin D testing is covered in LPS 114 Vitamin D testing. The following groups are at risk of vitamin D deficiency: NHS Stockport Local Policy All pregnant and breastfeeding women, especially teenagers and young Statement women; Infants and young children under 5 years of age; Older people No.114a aged 65 years and over; People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods; People who have darker skin, for example people of African, African-Caribbean and South Asian origin, because their bodies are not able to make as much vitamin D. People in the above categories should be encouraged to purchase over the counter supplements unless they are eligible for Health Start vitamins and should not be prescribed on the NHS In line with the GMMMG NTS guidance issued in July 2011 NHS Stockport commissions the use of zoledronic acid (Aclasta) infusion for NHS Stockport the treatment of post-menopausal osteoporosis only for those patients Local Policy intolerant of oral bisphosphonate drugs or with established compliance or Statement No.147 swallowing problems
Mar 2012 - The Group felt that this policy was not discriminatory as patients were advised to but over the counter and if they were on benefits then they could receive them under the appropriate scheme.
Specialty
Procedure
Policy Statement
Dermatology
Infliximab or adalimumab for hidradenitis suppurativa
No
Infliximab and Adalimumab are commissioned on an individual patient basis for the treatment of hidradenitis suppurativa with the following restrictions: The condition is refractory to or the patient is unable to tolerate commonly used first and second line treatments including selfcare, antibiotics (most commonly rifampicin and clindamycin), Roaccutane, corticosteroids and immunosuppressants (cyclosporine, azathioprine and methotrexate); AND The patient has a DLQI of greater or NHS Stockport Mar 2012 - The Group equal to 21; AND The patient has a GHQ12 score>15 (or >20 and all Local Policy felt that this policy was systemic agents not used in that patient); AND The patient has had one or Statement No.163 not discriminatory. more admissions to control symptoms in the last 12 months; AND Surgical options have been considered; AND The patient has been counselled (and this is clearly documented) about potential adverse effects of the drug treatment. It is expected that treatment using infliximab or adalimumab will be funded for a trial period of 4 months, with continuation of funding being agreed only if the patient responds adequately. Routine funding will then continue until the patient loses response.
Rheumatology
Sildenafil for systemic Prior sclerosis with severe approval Raynaud's EUR team phenomenon
No
NHS Stockport commissions sildenafil for patients with severe Raynauds phenomenon secondary to systemic sclerosis on a prior approval basis
Haematology
Eculizumab
Not supported
N/A
NHS Stockport does not commission eculizumab for indications other than paroxysmal nocturnal haemoglobinuria (including antibody-mediated NHS Stockport rejection, Guillain-Barre Syndrome, atypical haemolytic uraemic Local Policy syndrome, thrombotic thrombocytopenic purpura (TTP) and systemic Statement No.161 lupus erythematosus (SLE)) because the use of eculizumab in these conditions is considered to be experimental. This treatment is commissioned on an individual patient basis as there is limited published evidence of effectiveness. NHS Stockport Local Policy Statement No. 40
Ophthalmology
IVIG for MAR Prior (melanoma associated approval retinopathy) EUR team
No
Specialty
Procedure
Pain management
Capsaicin patch
Prior approval Category Commissioning Positition Policy Statement form available NHS Stockport commissions capsaicin patch (Qutenza) where the following criteria are met: the patient has severe, non-diabetic neuropathic NHS Stockport Group pain unresponsive to multimodal neuropathic analgesics; the patients N/A Local Policy approval pain significantly impairs activities of daily living as demonstrated on the Statement No. 167 Brief Pain Inventory; and the patient is under the care of a specialist pain clinic. No This is commissioned for patients with refractory autoimmune haemolytic anaemia at the lowest clinically effective dose. For appropriate patients, rituximab should be considered before treatment with IVIg. Plerixafor is commissioned by NHS Stockport in patients requiring stem cell mobilisation prior to an autologous stem cell transplant, where: there was insufficient stem cell mobilisation with G-CSF; and the stem cell transplant is a standard treatment for the type and severity of disease the patient has. NHS Stockport does not commission colesevelam for bile acid malabsorption owing to a lack of evidence of superiority over the current standard treatment of colestyramine.
May 2012 - The Group felt that this policy was not discriminatory.
Haematology
Rituximab for AIHA Prior (Autoimmune approval haemolytic anaemia) EUR team Prior approval EUR team
NHS Stockport June 2012 - The Group Local Policy felt that this policy was Statement No. 55 not discriminatory. NHS Stockport June 2012 - The Group Local Policy felt that this policy was Statement No. 71 not discriminatory. NHS Stockport Aug 2012 - The Group Local Policy felt that this policy was Statement No. 207 not discriminatory.
Oncology
Plerixafor
No
Gastroenterology
Colesevelam
Not supported
N/A
General Practice
Omacor
Not supported
N/A
In line with the GMMMG NTS guidance issued in May 2012 NHS NHS Stockport Aug 2012 - The Group Stockport does not commission Omacor for the secondary prevention of Local Policy felt that this policy was myocardial infarction. Statement No. 206 not discriminatory. NHS Stockport does not commission erythropoietin for anaemia associated with myeloma owing to inadequate evidence of cost effectiveness In line with the GMMMG Neurosciences Medicines Management group guidance issued in May 2012 NHS Stockport commissions alemtuzumab for multiple sclerosis for patients: with rapidly evolving severe (RES) multiple sclerosis; who have failed on licensed natalizumab (Tysabri), fingolimod (Gilenya) or unlicensed mitoxantrone; and where the treatment will be initiated by a consultant neurologist with a special interest in multiple sclerosis. NHS Stockport Jul 2012 - The Group Local Policy felt that this policy was Statement No. 201 not discriminatory.
Haematology
Erythropoietin
Not supported
N/A
Neurology
Alemtuzumab
No
NHS Stockport Aug 2012 - The Group Local Policy felt that this policy was Statement No. 205 not discriminatory.
Specialty
Procedure
Prior approval Category Commissioning Positition form available Not supported N/A NHS Stockport does not commission idebenone for Lebers hereditary optical neuropathy, where both eyes have poor vision, owing to inadequate evidence of efficacy.
Policy Statement
Ophthalmology
Idebenone
NHS Stockport Aug 2012 - The Group Local Policy felt that this policy was Statement No. 208 not discriminatory.
Endocrinology
Linagliptin
In line with the GMMMG NTS guidance issued in September 2011 NHS Stockport commissions linagliptin as an option for the treatment of type 2 diabetes to improve glycaemic control in adults; as monotherapy, in NHS Stockport Sep 2012 - The Group combination with metformin or in combination with metformin and a Local Policy felt that this policy was sulphonylurea; in those patients who fulfill the criteria for a DDP-4 inhibitor Statement No. 210 not discriminatory. as per NICE Clinical Guideline CG87. The DDP-4 inhibitor with the cheapest acquisition cost should be used first line; however linagliptin may be a suitable choice in those patients with renal impairment. Not supported In line with the GMMMG NTS guidance issued in July 2012 NHS Stockport does not commission Pollinex Quattro subcutaneous vaccine for the treatment of seasonal allergic rhinoconjunctivitis NHS Stockport Sep 2012 - The Group Local Policy felt that this policy was Statement No. 217 not discriminatory.
ENT
Pollinex Quattro
N/A
General Medicine / General Practice
Rifaximin
Not supported
N/A
In line with the GMMMG NTS guidance issued in June 2012 NHS NHS Stockport Sep 2012 - The Group Stockport does not commission rifaximin (Xifaxanta) for the treatment Local Policy felt that this policy was of travellers diarrhoea (licensed indication) or for the treatment of Statement No. 215 not discriminatory. Clostridium Difficile infection (unlicensed indication). In line with the GMMMG NTS guidance issued in June 2012 NHS Stockport commissions fidaxomicin (Dificlir) as a treatment option NHS Stockport Sep 2012 - The Group following a second relapse, i.e. as third line therapy, of Clostridium Difficile Local Policy felt that this policy was infection. Fidaxomicin should be initiated by a microbiologist or under Statement No. 216 not discriminatory. microbiologist recommendation and is not to be prescribed in primary care
General Medicine / General Practice
Fidaxomicin
Specialty
Procedure
Policy Statement
Pain management
Tapentadol (Palexia) Not immediate and supported prolonged release
N/A
In line with the GMMMG NTS guidance issued in June 2011 NHS Stockport does not commission tapentadol (Palexia) immediate and prolonged release for the treatment of acute and chronic severe pain
Sep 2012 - The Group recognised the impact this policy will have on patients with long-term conditions, who are protected under the characteristic of NHS Stockport disability in the Equality Local Policy Act. However, as the Statement No. 209 decision was taken primarily on the grounds of clinical effectiveness and health benefits to patients the Group has agreed that this does not amount to discrimination.
Psychiatry
Asenapine
Sep 2012 - The Group recognised the impact this policy will have on patients with long-term conditions, who are protected under the In line with the GMMMG NTS guidance issued in March 2012 NHS characteristic of Stockport commissions asenapine as a treatment option for the treatment NHS Stockport disability in the Equality of manic episodes in adults with bipolar I disorder as per Mental Health Local Policy Act. However, as the Trust recommendations as part of an in-patient treatment regimen for the Statement No. 213 decision was taken acute phase only. Asenapine for the treatment of manic episodes in primarily on the grounds adults with bipolar I disorder is not to be prescribed in primary care. of clinical effectiveness and health benefits to patients the Group has agreed that this does not amount to discrimination.
Specialty
Procedure
Policy Statement
Psychiatry
Paliperidone depot injection
Not supported
N/A
Sep 2012 - The Group recognised the impact this policy will have on patients with long-term conditions, who are protected under the characteristic of In line with the GMMMG NTS guidance issued in January 2012 NHS NHS Stockport disability in the Equality Stockport does not commission paliperidone depot injection (Xeplion) for Local Policy Act. However, as the schizophrenia Statement No. 212 decision was taken primarily on the grounds of clinical effectiveness and health benefits to patients the Group has agreed that this does not amount to discrimination. Sep 2012 - The Group recognised the impact this policy will have on In line with the GMMMG NTS guidance issued in March 2012 NHS patients with long-term Stockport commissions belimumab for SLE for patients: with 4 or more conditions, who are American College of Rheumatology criteria for SLE; ANA or dsNDNA protected under the positive at the time of assessment; with active disease (SLEDAI of 6 or characteristic of more or 1 BILAG A or 2 BILAG B); with positive dsDNA or low NHS Stockport disability in the Equality complement; with not a predominant renal or CNS flare; AND not eligible Local Policy Act. However, as the for a clinical trial. Initiation of belimumab is restricted to tertiary specialist Statement No. 214 decision was taken clinicians; this may involve direct initiation or the advice to initiate following primarily on the grounds assessment of patient after referral. Discontinuation of belimumab of clinical effectiveness should be considered if there is no improvement in disease control after 6 and health benefits to months of treatment. patients the Group has agreed that this does not amount to discrimination.
Rheumatology
Belimumab
Specialty
Procedure
Policy Statement
Urology
Degarelix
In line with the GMMMG NTS guidance issued in November 2011 NHS Stockport does not commission the routine use of degarelix for the treatment of hormone dependent advanced prostate cancer. However it may be a valuable treatment option in those patients who are particularly vulnerable to the clinical effects of a testosterone flare. These patients may include those: (a) at risk of neurological compromise due to metastases, (b) with urethral or bladder outlet obstruction due to local encroachment or metastatic disease.
Sep 2012 - The Group recognised the impact this policy will a differential impact on men who are protected under the characteristic of sex in the Equality NHS Stockport Act. However, as the Local Policy decision was taken Statement No. 211 primarily on the grounds of clinical effectiveness and health benefits to patients the Group has agreed that this does not amount to discrimination.
General Practice
Insulin degludec
Not supported
N/A
In line with the GMMMG NTS guidance issued in July 2012 NHS Stockport does not commission insulin degludec (Tresiba) for the treatment of diabetes mellitus (Type 1 and Type 2) where insulin is required.
Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of NHS Stockport disability, but did not Local Policy discriminate as the Statement No. 218 clinical evidence suggests this intervention is no more effective than alternatives
Specialty
Procedure
Policy Statement
General Practice
Zostavax
Not supported
N/A
NHS Stockport does not commission Zostavax for the prevention of shingles in adults aged over 50 outside of the national vaccination programme.
Oct 2012 - The Group recognised that the policy had a greater NHS Stockport impact on the protected Local Policy characteristic of age, Statement No. 221 but did not discriminate as the clinical evidence supports the policy decision
Haematology
Deferasirox
No
In line with GMMMG guidance issued in October 2007 NHS Stockport commissions oral iron chelators as first-line in patients aged over 6 years with beta thalassaemia major for chronic iron overload due to frequent blood transfusions; second-line in iron overload in patients with beta thalassaemia major, requiring infrequent blood transfusions and in NHS Stockport patients with other anaemias including sickle cell patients and patients Local Policy aged 2-5 years, when desferrioxamine therapy is not tolerated, Statement No 109 contraindicated or inadequate. NHS Stockport does not commission oral iron chelators as first-line for the treatment of iron overload in patients with refractory anaemias (myelodysplastic syndromes, aplastic anaemia, myelofibrosis, red cell aplasia)
Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of ethnicity, but did not discriminate as the clinical evidence supports the policy decision
Urology
Prior Botulinum for Urinary approval Incontience EUR team
Yes
This treatment is commissioned on an individual basis, for adults and children, where urinary incontinence results from idiopathic or neurogenic detrusor overactivity, which is refractory to treatment with anticholinergics. NHS Stockport This treatment is commissioned on an individual basis, for adults and Local Policy children, with spinal cord disease and with urodynamic investigations Statement No. 15 showing impaired bladder storage and in whom antimuscarinic drugs have proved to be ineffective or poorly tolerated.
Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence supports the policy decision.
Specialty
Procedure
Category Position statement Not supported Prior approval - EUR team
Prior approval form N/A
Commissioning Positition Requests for referral to an ineligible out of area service/provider will be considered on an individual basis in certain cases.
Policy Statement
Equality and Diversity checked Jun-09
Out of Area treatments Alternative / Complementary therapies Audiology Hypnotherapy for Irritable Bowel (IBS) Bone Anchored Hearing Aid Enhanced External Counterpulsation (EECP)
N/A
Yes
NHS Stockport Local Policy Statement No. 24 This therapy Is considered LOW PRIORITY. Hypnotherapy for the NHS Stockport Local Policy treatment of IBS is not commissioned due to insufficient evidence of Statement No. 16 effectiveness NHS Stockport Commissioned on a individual patient basis Local Policy Statement No. 87 This procedure is considered to be experimental and is not commissioned. NHS Stockport Local Policy Statement No. 173
Jun-09
Jun-09
Cardiology
Not supported
N/A
Jun-09
Colorectal
Sacral Nerve Prior approval Modulation for faecal - EUR team incontinence
Yes
NHS Stockport commissions sacral nerve modulation for faecal incontinence where there is an intact anal sphincter AND severe NHS Stockport incontinence of liquid or solid faeces AND an unsatisfactory response to all Local Policy appropriate non-surgical treatments and any previously attempted surgical Statement No. 20 ones AND a satisfactory response to a test procedure. NHS Stockport will only fund wisdom teeth extraction for patients meeting the criteria in NICE TA1 NICE TA 1
Jun-09
Dental
Wisdom teeth
Prior approval - CCC
Yes
Dermatology
Dermatology Minor surgery (for cosmetic and benign skin lesions)
Group approval
N/A
Dermatology
Epilation of facial hair Not supported in males Hyperhidrosis surgery or botulinum toxin injections Laser treatment for acne scarring
N/A
Dermatology
Not supported
N/A
Dermatology
Not supported
N/A
Dermatological procedures that are purely cosmetic in nature are considered LOW PRIORITY and hence not commissioned. Lipomas and NHS Stockport sebaceous cysts that may be painful of become infected are not defined as Local Policy cosmetic for these purposes. Removal of skin lesions within secondary Statement No. 3 & care will only be considered if: lesions are suspicious or potentially No. 22 malignant; there is impairment of function or significant facial disfigurement. Epilation of facial hair in males is considered LOW PRIORITY and is not commissioned. An exception is made for males with severe NHS Stockport pseudofolliculitis who can not reduce their frequency of shaving, for Local Policy example, firemen who need to be close shaved to allow proper fitting of Statement No. 4n their airway masks. These therapies are considered LOW PRIORITY. Treatment of NHS Stockport Local Policy hyperhidrosis with surgery or botulinum toxin injections is not Statement No. 31 commissioned. NHS Stockport This treatment is considered LOW PRIORITY. Laser treatment for acne Local Policy scarring is not commissioned Statement No. 4
Jun-09
Jun-09
Jun-09
Jun-09
Specialty
Procedure
Category
Prior approval form
Commissioning Positition
Policy Statement
Dermatology
Tattoo removal
Not supported
N/A
NHS Stockport will consider removal of tattoos in the following cases: where the tattoo is the result of trauma, inflicted against the patients will (rape tattoo); the patient was not Gillick competent, and therefore not responsible for their actions, at the time of the tattooing; exceptions may NHS Stockport also be made for tattoos inflicted under duress during adolescence or Local Policy disturbed periods where it is considered that psychological rehabilitation, Statement No. 4h break up of family units or prolonged unemployment could be avoided, given the treatment opportunity. (Only considered in very exceptional circumstances where the tattoo causes marked limitations of psycho-social function). Children should meet one of the following criteria: Persistent bilateral OME with a hearing level in better ear of 2530 dBHL or worse confirmed over 3 months; or persistent bilateral OME with hearing loss less than 2530 dBHL and significant impact on childs developmental, social or educational status. X-rays of sinuses are not routinely commissioned Treatment is available at South Manchester, however all patients should be referred by a chest physician before being referred for treatment and not referred directly to South Manchester NHS Stockport Local Policy Statement No. 171 NHS Stockport Local Policy Statement No. 172 NHS Stockport Local Policy Statement No. 11
Jun-09
ENT
Grommets/Surgical Treatment of Otitis Media
Yes
Jun-09
ENT
Sinus x-ray
Not supported
N/A
Jun-09
ENT
Surgical treatment for Prior approval sleep apnoea - EUR team
Yes
Jun-09
ENT
Surgical Treatment for Not supported Snoring
N/A
Treatment solely for snoring is considered LOW PRIORITY. The PCT will not normally fund treatment when snoring is the sole problem. Only snorers with at least one of the following symptoms present should be referred for assessment for sleep apnoea: daytime sleepiness, not just NHS Stockport Local Policy tiredness (Epworth Sleepiness Score >9); witnessed regular or frequent episodes, as opposed to occasional, of stopping breathing during sleep; Statement No. 11a waking from sleep with choking / obstructed episodes; regular waking feeling unrefreshed; large neck circumference (17 inches or over) or significant retrognathism; small oedematous pharynx on visual inspection. This investigation is commissioned on an individual basis in line with NICE guidance where patients meet one of the following criteria for investigation: Overt or transfusion dependent bleeding from the GI tract, when the source was not identified on OGD and colonoscopy; Crohns disease; or Hereditary GI polyposis syndromes. NHS Stockport Local Policy Statement No. 9
Jun-09
Gastroenterolog y
Wireless Capsule Enteroscopy for Investigation of the Small Bowel
Prior approval - EUR team
Yes
Jun-09
General Practice
Screening test
Not supported
N/A
Tests for employment medicals and paternity testing are not commissioned NHS Stockport as they are low priority. Patient requests for screening tests outside of Local Policy national programmes should only be done when clinically indicated Statement No. 35
Jun-09
Specialty
Procedure
Category
Prior approval form
Commissioning Positition NHS Stockport funds referral to a specialist service for patients in whom varicosities are present or suspected in the following circumstances: they are bleeding from a varicosity that has eroded the skin; they have bled from a varicosity and are at risk of bleeding again; they have an ulcer which is progressive and/or painful or they have a stable, pain-free, ulcer and/or progressive skin changes that may benefit from surgery / sclerotherapy. This treatment is commissioned on an individual patient basis
Policy Statement
General Surgery
Varicose veins
Yes
Jun-09
Haematology
Extracorporeal photopheresis for GvHD
No
NHS Stockport Local Policy Statement No.45
Jun-09
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy
Notified approval
N/A
This treatment is commissioned for decompression illness, gas embolism and carbon monoxide poisoning in patients at high-risk of immediate or long-term complications. This treatment is not commissioned for diabetic lower extremity ulcers, venous ulcers, pressure ulcers, other chronic wounds, crush injuries, blunt chest injury, acute ophthalmological ischaemia, grafts and flaps, necrotising soft-tissue infections,surgical site infections, livedoid vasculopathy, acute coronary syndrome, stroke, traumatic brain injury, soft tissue radionecrosis, osteoradionecrosis, cancers and tumour sensitisation to radiotherapy, chronic refractory osteomyelitis, surgery, cardio-pulmonary bypass, urology, headache, multiple sclerosis, thermal burns, sports injuries, osteonecrosis of the mandible, peridontitis, chronic hepatitis, Crohns disease, Bells palsy, pain syndromes, cognitive impairment, calciphylaxis, infertility, severe anaemia and malignant otitis externa.
NHS Stockport Local Policy Statement No.44
Jun-09
Minor Surgery
Removal of Haemorrhoidal Skin Tags Specialist epilepsy services
Not supported
N/A
This procedure should not be performed. There may be consideration of special circumstances e.g. recurrent bleeding Some specialist epilepsy services are commissioned on an individual basis. A maximum of one week for videotelemetry and one week for assessment will be commissioned. Other specialist epilepsy services are not commissioned, including residential care. Commissioned on a individual patient basis
NHS Stockport Local Policy Statement No.174 NHS Stockport Local Policy Statement No. 12 NHS Stockport Local Policy Statement No. 32 NHS Stockport Local Policy Statement No. 175
Jun-09
Neurology
No
Jun-09
Neurology
Functional electrical Prior approval stimulation for dropped - EUR team foot Functional electrical stimulation for facial palsy Prior approval - EUR team
No
Jun-09
Neurology
No
Commissioned on a individual patient basis
Jun-09
Specialty
Procedure
Category
Prior approval form Yes
Neurology
Vagal nerve Prior approval stimulators for epilepsy - EUR team
Commissioned on an individual basis in line with NICE guidance (IPG050) This procedure should only be undertaken in exceptional circumstances as risk of anaesthesia, uterine perforation and cervical laceration have been identified in Effective Healthcare Bulletin 9 as outweighing the minimum potential benefit. In the investigation of dsyfunctional uterine bleeding, hysteroscopy with selected biopsy or curettage is superior to routine dilatation and curettage Hysterectomy should only be undertaken if patients have followed the map of medicine pathway, or are on a cancer referral pathway
Diagnostic Dilation and Curettage for Women Not supported <40
N/A
Jun-09
Hysterectomy (abdominal and vaginal)
Group approval Prior approval - CCC with reference to EUR team Prior approval - EUR team
N/A
Jun-09
Vaginal ring pessaries in secondary care
No
Replacement of vaginal ring pessaries should be undertaken out of NHS Stockport hospital by a GP or the tier 2 service. A patient may be referred to Local Policy secondary care if replacement is difficult. Statement No. 177 NHS Stockport Local Policy Statement No. 178
Jun-09
Oncology
MUD
No
Approved on an individual basis according to certain criteria.
Jun-09
Oncology
Positron Emission Tomography (PET) scans
Group approval
N/A
This is commissioned for certain clinical indications, namely: staging of non-small cell lung cancer prior to surgery or radical radiotherapy; a ssessment of solitary pulmonary nodule ONLY when biopsy not safe or practicable; re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs; re-staging of colon cancer following surgery and radiotherapy; initial & re-staging of Hodgkins Lymphoma; initial & re-staging of diffuse large B-cell lymphoma; staging of NHS Stockport oesophageal cancer prior to radical surgery; assessment for malignant Local Policy neck nodes from unknown primary site in head and neck; re-staging of Statement No. 49 suspected recurrent non-CNS head & neck cancer following surgery or radiotherapy; re-staging of thyroid cancer serum thyroglobulin raised & radio-iodine imaging negative; Staging of malignant melanoma prior to radical surgery for localized or metastatic disease. Diagnosing an unknown primary where there are no secondary metastases but which has caused a paraneoplastic syndrome . This is not commissioned as there is limited published evidence of effectiveness. NHS Stockport Local Policy Statement No. 36
Jun-09
Ophthalmology
Intraocular telescope for age-related Not supported macular degeneration
N/A
Jun-09
Specialty
Procedure
Category
Commissioning Positition This is considered LOW PRIORITY and hence not commissioned. This includes laser correction of short sightedness; and insertion of intraocular lens for correction of refractive error. This treatment will be reviewed on an individual basis where patients blood CO2 levels are high enough.
Policy Statement NHS Stockport Local Policy Statement No. 39 NHS Stockport Local Policy Statement No. 18
Ophthalmology Surgery for Short Sight Not supported Nocturnal NonPrior approval Invasive Ventilation for - EUR team Muscular Dystrophy
Paediatrics
No
Jun-09
Bleopharoplasty upper Prior approval Plastic Surgery lid (Surgery on the - CCC upper eyelid) Bleopharoplasty lower Prior approval lid (Surgery on the - CCC lower eyelid)
Yes
This procedure will be commissioned to correct functional impairment (not purely for cosmetic reasons) as demonstrated by: impairment of visual fields in the relaxed, non-compensated state; or clinical observation of poor eyelid function, discomfort, e.g. headache worsening towards end of day and/or evidence of chronic compensation through elevation of the brow This is available for correction of ectropion or entropion or for the removal of lesions of the eyelid skin or lid margin. Revisional surgery will only be considered if the NHS commissioned the original surgery. If revisional surgery is being carried out for implant failure, the decision to replace the implant(s) rather than simply remove them should be based upon the clinical need for replacement and whether the patient meets the policy for augmentation at the time of revision Rhinoplasty should be available for: problems caused by obstruction of the nasal airway; objective nasal deformity caused by trauma; correction of complex congenital conditions e.g. Cleft lip and palate; patients with isolated airway problems (in the absence of visible nasal deformity) may be referred initially to an ENT consultant for assessment and treatment. These procedures will be considered for treatment of: congenital facial abnormalities; facial palsy (congenital or acquired paralysis); as part of the treatment of specific conditions affecting the facial skin e.g. cutis laxa, pseudoxanthoma elasticum, neurofibromatosis; to correct the consequences of trauma; to correct deformity following surgery. Repair of split ear lobes will not normally be commissioned even when the split ear lobe is the result of trauma.
NHS Stockport Local Policy Statement No. 4d NHS Stockport Local Policy Statement No. 4e NHS Stockport Local Policy Statement No. 4b
Jun-09
Plastic Surgery
Yes
Jun-09
Plastic Surgery
Revision of breast augmentation
Not supported
N/A
Jun-09
Plastic Surgery
Rhinoplasty (Surgery Prior approval to reshape the nose) - EUR team
Yes
NHS Stockport Local Policy Statement No. 4f
Jun-09
Plastic Surgery
Rhytidectomy (Face lifts and brow lifts)
Yes
NHS Stockport Local Policy Statement No. 4c NHS Stockport Local Policy Statement No. 4i
Jun-09
Plastic Surgery
Split ear lobes
Not supported
N/A
Jun-09
Specialty
Procedure
Category
Prior approval form
Commissioning Positition Treatment for gender dysphoria via gender reassignment is a low priority and will only be agreed in accordance with the referral criteria and collaborative commissioning arrangements. Patients with gender dysphoria should be registered with a Stockport GP Practice. Referrals for gender reassignment will only be made through the NHS general psychiatrist in Stockport with the support of the patients GP.
Policy Statement
Psychiatry
Gender Dysphoria
No
Jun-09
Respiratory
Cough Assist Machine
No
New equipment is commissioned if there are no machines available. This treatment will not be routinely commissioned but funding will be considered for endoscopic lumbar decompression as part of peer reviewed randomised control trials that compare endoscopic laser foraminoplasty to either conservative therapy or to conventional surgery such as spinal fusion. This procedure is considered to be experimental and is not commissioned
NHS Stockport Local Policy Statement No. 179 Greater Manchester Evidence Review No. 13 NHS Stockport Local Policy Statement No. 47 NHS Stockport Local Policy Statement No. 48 NHS Stockport Local Policy Statement No. 13 NHS Stockport Local Policy Statement No. 180 NHS Stockport Local Policy Statement No. 52 NHS Stockport Local Policy Statement No. 53
Jun-09
Trauma & Orthopaedics
Endoscopic Lumbar Decompression Femoroacetabular (hip) impingement surgery
Not supported
N/A
Jun-09
Not supported
N/A
Jun-09
TAMARS (Technology Assisted Not supported Micromobilisation and Reflex Stimulation) Treatment at the Spinal Foundation Artificial urinary sphincter Not supported
N/A
This procedure is not commissioned
Jun-09
N/A
These services are rarely commissioned and only as part of an approved randomised controlled trial. This procedure is an established treatment that is rarely performed. This procedure is commissioned on an individual patient basis.
Jun-09
Urology
No
Jun-09
Urology
ESWT (Extracorporeal Shockwave Therapy) Not supported for prostadynia or pelvic floor syndrome Hyperthermia treatment for prostadynia or pelvic floor syndrome
N/A
This is not commissioned as there is limited evidence of effectiveness.
Jun-09
Urology
Not supported
N/A
This is not commissioned as there is limited evidence of effectiveness
Jun-09
Specialty
Procedure
Category
Prior approval form
Policy Statement
Urology
Sacral Nerve Modulation
Yes
This treatment is usually commissioned on an individual basis for patients NHS Stockport in one or more of the following categories: individuals with urinary urge Local Policy incontinence where conventional treatment has failed; individuals with Statement No. 20 urgency-frequency where conventional treatment has failed. Provision of vasectomy should only be undertaken in a primary care setting, it is not commissioned as a secondary care service. However it is noted that referral to secondary care may be required in some circumstances e.g. GA for needle phobics. NHS Stockport Local Policy Statement No. 181
Jun-09
Urology
Vasectomy in secondary care setting
Prior approval - CCC with reference to EUR team
No
Jun-09
Vascular Surgery
Chelation Therapy for Not supported Vascular Occlusions
N/A
Allergy
Breakspear Hospital
Not supported
N/A
Diagnostics
Direct access to open Not supported MR scanner
N/A
Greater This treatment is a medical alternative to surgery for treatment of vascular Manchester occlusions. Clear evidence will have to be presented that the type of Evidence Review intervention is clinically effective before it is supported. No. 12 NHS Stockport Services at the Breakspear Hospital are not commissioned Local Policy Statement No. 54 This is not commissioned. Patients who cannot tolerate or whose BMI NHS Stockport precludes a normal MR scan should be referred directly to the preferred Local Policy secondary care provider as other diagnostic tests may be available in the Statement No. 182 secondary care settting. Donor insemination is not funded NHS Stockport Local Policy Statenment No. 82
Jun-09
Sep-09
Sep-09
Donor insemination
Not supported
N/A
Sep-09
Plastic Surgery
Apronectomy / abdominoplasty
Yes
Funding for apronectomy / abdominoplasty will only be considered when the patient : has excess abdominal skin as the result of significant weight loss; and has had a body mass index (BMI) of less than 30 for a minimum of 12 months; and the abdominal skin hangs below the symphysis pubis when standing; and there are clinical symptoms, for example: intertrigo or other chronic persistent / recurrent skin condition that is refractory to good hygiene and medical management, severe impairment of functionality (e.g. NHS Stockport ambulatory restrictions) that an appropriately trained clinician (i.e. doctor, Local Policy physiotherapist or occupational therapist) has documented is likely to be Statement No. 4l alleviated following surgery or problems associated with poorly fitted stoma bags that an appropriately qualified clinician (i.e. doctor or stoma nurse) has documented are likely to be alleviated following surgery. Patients meeting these criteria will be assessed by the Plastic Surgeons at South Manchester University Hospitals NHS Trust and only those cless they are eligible for Health Start vi
Feb-10
Specialty
Procedure
Category
Prior approval form
Commissioning Positition Therapies included in this section are considered LOW PRIORITY. Included in this section is: Acupuncture, Alexander Technique, Applied Kinesiology, Aromatherapy, Autogenic Training, Ayurveda, Chiropractic, Environmental Medicine, Osteopathy, Healing, Herbal Medicine, Hypnosis, Homeopathy, Massage, Meditation, Naturopathy, Nutritional Therapy, Reflexology, Reiki, Shiatsu, Other alternative therapies. Complementary medicine/alternative therapies are not funded as stand alone services. Acupuncture is available within some musculoskeletal care pathways.
Policy Statement
Not supported
N/A
Feb-10
Elective Caesarean section
Group approval
N/A
Intervention approved according to criteria established in guidelines issued jointly by NICE and National Collaborating Centre for Womens and Childrens Health. Planned caesarean section should only be routinely offered to women with: a term singleton breech (if external cephalic version is contraindicated or has failed), a twin pregnancy with breech first Greater twin, HIV (only if recommended by a HIV consultant), both HIV and Manchester hepatitis C (as above, there is no evidence that CS should be performed Evidence Review for hepatitis C alone), primary genital herpes in the third trimester (active No. 9 genital herpes at the onset of labour), grade 3 and 4 placenta praevia, two previous caesarean sections or more, previous upper segment caesarean section or type unknown, previous significant uterine perforation/surgery breaching the cavity.
Feb-10
Audiology
Sequential cochlear implant
Not supported
N/A
Greater Manchester PCTS have agreed that for sequential cochlear NHS Stockport Nov-09 Age restriction implants, approval will only be given for those cases that are considered to Local Policy applies but this is in line be exceptional, rather than those cases whom the clinical team considers Statement No. 62 with NICE guidance will obtain sufficient benefit. Direct access barium enema is only available with prior approval from the EUR team. The reason for this is that barium enema is indicated for: suspected colorectal cancer. However these patients should be referred to a colorectal or anal cancer to a team specialising in the management of lower gastro-intestinal cancer as per the NICE CG27: referral for suspected cancer. These guidelines also state that when referring, no examinations or investigations other than abdominal and rectal NHS Stockport examination and full blood count are recommended as this may delay Local Policy referral; suspected diverticulitis. However other investigations such as Statement No. 69 colonoscopy and CT scan should be considered first; suspected inflammatory bowel disease. However the investigation of suspected inflammatory bowel disease should be lead by a specialist; treatment of some conditions, such as intersusseption. However the treatment of these conditions with barium enema should be initiated by a specialist. Barium enemas deliver a high radiation dose (equiesponds adequately. Routine fun
General Practice
Direct access barium Not supported enema
N/A
Specialty
Procedure
Category
Prior approval form
Policy Statement
Dermatology
Cutaneous and plantar Prior approval warts - CCC
Yes
Warts normally resolve spontaneously although this may take up to 2 years. Treatment for warts should only be considered if warts: are symptomatic i.e. painful or itchy; or interfere with functioning; or have been present for more than two years; or have spread extensively. Treatment should initially be by duct tape occlusion, if this is unsuccessful then treatment with topical salicylic acid should be considered. Treatment with NHS Stockport cryotherapy should only be considered if treatment with both duct tape Local Policy occlusion and topical salicylic acid has not cleared the wart. Referral to Statement No. 68 the tier 2 dermatology service should only be considered if: there is genuine doubt about the diagnosis; or the wart is recalcitrant or rapidly growing; or malignancy is suspected (malignant changes in warts are extremely rare but should be excluded in older people or people with immunosuppression or subungual warts.)
Feb-10
Obstetrics & gynaecology
Pre-implantation genetic diagnosis (PIGD)
Yes
PIGD will be funded for those couples meeting the following criteria: the genetic condition is included on the list of conditions licensed for PIGD by the Human Fertilisation and Embryology Authority (HFEA); the female partner is aged between 23 and 39 years old at the time of treatment; the NHS Stockport female partners BMI is between 19-29; both partners are non-smokers; Local Policy both partners can give assurance that alcohol intake is within Department Statement No. 67 of Health guidelines and they are not using recreational drugs; neither partner has previously undergone a sterilisation procedure. One cycle of PIGD will be funded, if a live birth is not achieved from this one cycle, one further cycle will be funded.
Feb-10 whether this policy discriminated against couples requiring IVF to conceive who already had a child (and therfore are ineligible for IVF on the NHS) was considered but it was felt that this was a policy for different indication and therefore it was not discriminatory
Minor Surgery
Prior approval Surgery for ingrown - CCC with toenails in secondary reference to care EUR team
No
Surgery for ingrown toenails is not routinely commissioned in a secondary care setting. Surgery for ingrowing toenails may be performed in secondary care when future orthopaedic surgery would be compromised. For example, a recurrently infected ingrowing toe nail requiring treatment prior to joint replacement surgery. Referral to secondary care for failed primary care management requires prior approval from the EUR team.
Mar-10
Specialty
Procedure
Category
Prior approval form
Policy Statement
Minor Surgery
Dermatology Minor surgery (for cosmetic Prior approval and benign skin - CCC lesions)
Yes
Dermatological procedures that are purely cosmetic in nature are considered LOW PRIORITY and hence not commissioned. Lipomas and sebaceous cysts that may be painful of become infected are not defined as cosmetic for these purposes. Removal of skin lesions within secondary NHS Stockport care will only be considered if: lesions are suspicious or potentially Local Policy malignant; or there is impairment of function or significant facial Statement No. 3 & disfigurement. Lipoma over 15cm in size are at risk of being malignant No. 22 and should be sent on a 2 week pathway proforma. Under no circumstances should a biopsy/excision of lipomas over 15cm in size be undertaken by anyone who is unable to perform / coordinate a compartmental resection if required. Direct access barium enema is only available with prior approval from the EUR team This procedure is considered to cosmetic and hence low priority. NHS Stockport does not commission labiaplasty / labioplasty NHS Stockport Local Policy Statement No. 69 NHS Stockport Local Policy Statement No. 4p
Mar-10
General Practice
Direct access to barium enema Labiaplasty
Not supported
N/A
Feb-10
Plastic Surgery
Not supported
N/A
Mar-10
Local risk sharing schemes between a hospital, NHS Stockport and the manufacturer of the policy position drug to give patients access to a drug that would otherwise not be commissioned on costeffectiveness grounds.
N/A
Risk sharing schemes are a way of reducing the overall cost of a drug for a specific disease, through a special agreement with the manufacturer. On a national scale, risk sharing schemes (also known as patient access schemes) exist between the Department of Health and pharmaceutical NHS Stockport manufacturers for NICE approved technologies (TAs). A local risk sharing Local Policy scheme is an agreement between a hospital, its PCT and the Statement No. 66 manufacturer of the drug, used to give patients access to a drug that would otherwise not be commissioned on cost-effectiveness grounds. NHS Stockport will not enter into local risk sharing schemes. Diagnostic knee arthroscopy should not be carried out for the investigation of knee pain unless an MR scan is contraindicated (e.g. because of foreign body in the eye, pacemaker or cerebral clips) Therapeutic knee arthroscopy may be used for the following where conservative measures NHS Stockport have failed or unlikely to be effective: removal of loose body, meniscal Local Policy surgery (repair or resection), ligament reconstruction/repair (including Statement No. 184 lateral release), synovectomy, treatment of localised chondral lesions. Knee arthroscopic washout alone should NOT be carried out for the treatment of osteoarthritis
Knee Arthroscopy
Yes
Mar-10
Specialty
Procedure
Category
Prior approval form
Policy Statement
General Practice
Ear irrigation
Group approval
N/A
NHS Stockport commissions ear irrigation for: removal of a foreign body from the ear canal; removal of excess wax where 3 weeks conservative NHS Stockport measures (e.g. wax softening with olive oil) have failed and where the Local Policy excess wax is impairing hearing or the wax needs removing prior to the Statement No. 76 fitting of a hearing aid. NHS Stockport does NOT commission ear irrigation where the sole indication is in preparation for an aircraft flight. Based on SIGN guidelines 117: Management of sore throat and indications for tonsillectomy. Watchful waiting is more appropriate than tonsillectomy for children with mild sore throats. Tonsillectomy is recommended for recurrent severe sore throat in adults. The following are recommended as indications for consideration of tonsillectomy for NHS Stockport recurrent sore throat in both children and adults: sore throats are due to Local Policy Statement No. 79 tonsillitis; the episodes of sore throat are disabling and prevent normal functioning; seven or more well documented, clinically significant, adequately treated sore throats in the preceding year; or five or more such episodes in each of the preceding two years; or three or more such episodes in each of the preceding three years.
May-10
ENT
Tonsillectomy for recurrent sore throat
Yes
May-10
Plastic Surgery
Breast enlargement (Augmentation mammoplasty)
Not supported
N/A
Jun-10 whether this policy discriminated Whilst there is evidence of the clinical effectiveness of augmentation NHS Stockport against transgender mammoplasty surgery this treatment is considered LOW PRIORITY and Local Policy individuals was hence not commissioned. Statement No. 4a discussed and it was agreed that it is not discriminatory Jun-10 whether this policy discriminated NHS Stockport against transgender Local Policy individuals was Statement No. 4j discussed and it was agreed that it is not discriminatory Jun-10 whether this policy discriminated NHS Stockport against transgender Local Policy individuals was Statement No. 4k discussed and it was agreed that it is not discriminatory
Plastic Surgery
Breast reduction
Not supported
N/A
Whilst there is evidence of the clinical effectiveness of reduction mammoplasty surgery this treatment is considered LOW PRIORITY and hence not commissioned
Plastic Surgery
Surgery for gynaecomastia
Not supported
N/A
Whilst there is evidence of the clinical effectiveness of surgery for gynaecomastia this treatment is considered LOW PRIORITY and hence not commissioned
Specialty
Procedure Surgery for unequal breast size
Category
Commissioning Positition Whilst there is evidence of the clinical effectiveness of surgery for unequal breast size this treatment is considered LOW PRIORITY and hence not commissioned
Policy Statement NHS Stockport Local Policy Statement No. 4r
Plastic Surgery
Not supported
Plastic Surgery
Hirsutism
Not supported
N/A
Plastic Surgery
Pinnaplasty / otoplasty (Correction of Not supported prominent ears) Donor Oocytes Not supported
N/A
Jun-10 whether this policy discriminated Whilst there is evidence of the clinical effectiveness of laser treatment and NHS Stockport against transgender electrolysis for hirsutism these treatments are considered LOW PRIORITY Local Policy individuals was and hence not commissioned. Statement No. 4m discussed and it was agreed that it is not discriminatory Whilst there is evidence of the clinical effectiveness of pinnaplasty and NHS Stockport otoplasty these treatments are considered LOW PRIORITY and hence not Local Policy Sep-10 commissioned Statement No. 4g Donor oocytes are not commissioned NHS Stockport Local Policy Statenment No. 82 Nov-10
N/A
Cryopreservation of oocytes
Not supported
N/A
01/11/2010 whether this policy discrimated against females as cryopreservation of sprem is a standard service was discussed Cryopreservation of oocytes is not commissioned by NHS Stockport as the NHS Stockport and it was agreed that Human Fertilisation and Embryology Authority (HFEA) still considers the Local Policy this was not technique to be experimental Statement No. 84 discriminatory as the evidence base for sprem cryopreservation is well developed whereas oocyte cryopreservation is still experimental
Continuous passive motion therapy for Prior approval rehabilitation after limb- EUR team preserving surgery for osteosarcoma
No
NHS Stockport commissions the rental of continuous passive motion (CPM) machines for rehabilitation after limb-preserving surgery for osteosarcoma
Sep-10
Specialty
Procedure
Category
Custom-made prosthetic limbs
Not supported
NHS Stockport will only fund prosthetic limbs that are provided as standard by the NHS.
Sep-10
Urology
Erectile dysfunction
Group approval
N/A
No more than four treatments (not tablets) per four weeks are prescribable. Tadalafil Once Daily may not be prescribed. Drug treatments for erectile dysfunction should only be prescribed by General Practitioners for patients who:have a chronic disease associated with erectile dysfunction e.g. diabetes, multiple sclerosis, Parkinsons disease, poliomyelitis, prostate cancer, severe pelvic injury, spina bifida and spinal cord injury; and / orare receiving dialysis for renal failure; and / orhave had radical pelvic surgery, prostatectomy or kidney transplant; orwere previously receiving Caverject, Erecnos, MUSE, Viagra, or Viridal for erectile dysfunction at the expense of the NHS on the 14th September 1998.Erectile dysfunction may be a side-effect of some drug treatments for chronic conditions where possible the drug should be changed to one NHS Stockport Local Policy which has less effect on erectile function. Drug treatments for erectile dysfunction may be prescribed where a drug switich is not possible and Statement No 33 where counteracting esponds adequately. Routine funding will then continue until the patient loses response.hotics.This also applies to vacuum pumps and constrictor rings for the treatment of erectile dysfunction. Penile prosthesis will be funded: as part of reconstructive treatment following surgery of the treatment of malignant or other diseases as part of reconstructive surgery following trauma and all non-surgical methods of treatment must previously have been exhausted. Penile Prosthesis will not be funded for cosmetic reasons. Patients with erectile dysfunction may make use of any NHS psychological and psychosexual counselling services that are available within the portfolio of service agreements. NHS Stockport does not commission services at The Bobath Centre for either new patients or patients that have previously been assessed and treated at the Centre. The service has not been commissioned for new patients for a number of years as there is lack of evidence of the superiority of the Bobath Centre over local services. This treatment is not commissioned owing to inadequate evidence of efficacy.
Sep-10
Neurology
Bobath therapy
Not supported
N/A
Sep-10
Urology
ESWT (Extracorporeal Shockwave Therapy) Not supported for Peyronies disease
N/A
Sep-10
Specialty
Procedure
Category
Commissioning Positition Winston's Wish is a charitable organisation providing residential courses for children suffering bereavement after the death of a parent. This service is not commissioned as local services are available.
Policy Statement NHS Stockport Local Policy Statement No. 63.
Psychiatry
Winston's Wish
Not supported
Sep-10
Audiology
Hearing Link
Not supported
N/A
Hearing Concern Link is an organisation that provides an intensive NHS Stockport psychosocial rehabilitation course for deafened adults. Local Policy NHS Stockport does not commission this service as there is a local service Statement No. 64 and the level of evidence provided by Hearing Link is low. NHS Stockport does not commission maintenance neurophysiotherapy except for children under the age of 19 with cerebral palsy. Only short courses of neurophysiotherapy (8 sessions) with well defined treatment goals will be commissioned for new patients. Only very short courses (4 sessions) with well defined treatment goals will be commissioned for previously treated patients experiencing a relapse that has had a significant effect on mobility. Surgery will not be funded unless the patient has at least one of the following: 1) metacarpophalageal joint contracture of 30 degrees or more 2) Any degree of proximal interphalangeal joint contracture. Surgery will not be funded unless the patient has at least one of the following: persistent triggering 12 months after a single steroid injection; recurrent triggering or has a fixed deformity that cannot be corrected with conservative measures
Sep-10
Neurology
Neurophysiotherapy
No
Sep-10
Trauma & Orthopaedics Trauma & Orthopaedics
Surgery for Dupuytren's contracture Surgery for trigger finger
Prior approval - OTS Prior approval - OTS
No
NHS Stockport Local Policy Statement No. 26 NHS Stockport Local Policy Statement No. 27
Nov-10
No
Nov-10
Surgery for bunion
Prior approval - OTS
No
Surgery will not be funded for the removal of bunions unless BOTH of the following criteria are met: 1) Confirmed diagnosis of hallux valgus associated with at least ONE of the following signs/symptoms attributable NHS Stockport to a hallux valgus deformity: a) difficulty walking b) significant and Local Policy persistent pain at the first metatarsal joint c) ulceration of the first Statement No. 29 metatarsal joint 2) signs/symptoms are unresponsive to at least six months of conservative treatment, including ALL of the following: a) padding b) analgesics or anti-inflammatory drugs c) appropriate footwear
Nov-10
Endocrinology
Pain management
Insulin pump therapy combined with continuous blood Not supported glucose monitoring for the treatment of type 1 diabetes Motion sensing neurostimulation for Not supported chronic pain
N/A
NHS Stockport does not commission insulin pump therapy combined with continuous blood glucose monitoring for the treatment of type 1 diabetes owing to insufficient evidence of effectiveness over current treatment with insulin pump therapy combined with standard blood glucose monitoring
Nov-10
N/A
NHS Stockport does not commission motion sensing neurostimulation for NHS Stockport chronic pain owing to insufficient evidence of effectiveness compared with Local Policy current neurostimulation devices. Statement No. 99
Nov-10
Specialty
Procedure
Category
Prior approval form
Policy Statement
Vascular Surgery
Angioplasty for chronic cerebrospinal venous Not supported insufficiency in multiple sclerosis
N/A
NHS Stockport does not commission angioplasty for chronic cerebrospinal NHS Stockport venous insufficiency in multiple sclerosis owing to insufficient evidence of Local Policy effectiveness. Statement No. 98 The standard statement in NICE Technology Appraisals People who are currently receiving the drug for the treatment of the condition and whose circumstances do not meet the criteria set out in this Technology Appraisal NHS Stockport should have the option to continue treatment until they and their clinicians Local Policy consider it appropriate to stop will not be applicable to patients coming off Statement No. 108 clinical trials unless the funding for these patients has been explicitly authorised by the commissioners in advance of commencement of the trials. NHS Stockport does not commission percutaneous mitral valve repair for the treatment of mitral regurgitation owing to inadequate evidence of clinical effectiveness NHS Stockport Local Policy Statement No. 111
Nov-10
NICE TA continuation of treatment clause
Position statement
N/A
Cardiology
Percutaneous mitral valve repair for mitral Not supported regurgitation
N/A
Cardiology
Transcatheter Aortic Valve Implantation (TAVI)
Not supported
N/A
In line with the current recommendation from the North West Specialist Commissioning Team (NWSCT), NHS Stockport does not commission Transcatheter Aortic Valve Implantation (TAVI). Whilst there is evidence NHS Stockport that TAVI is clinically effective a recent business case to NWSCT was Local Policy rejected and the procedure was not prioritised for new investment monies. Statement No. 106 However, NWSCT did agree that if the procedure could be provided within the provider services existing resources it would be commissioned. NHS Stockport does not commission gastroelectrical stimulation for gastroparesis owing to insufficient high quality evidence of effectiveness NHS Stockport Local Policy Statement No. 103
Gastroenterolog y
Gastroelectrical stimulation for gastroparesis Gluten free foods for gluten enteropathy
Not supported
N/A
General practice
Group approval
N/A
NHS supply of gluten free foods should only be for patients with NHS Stockport established gluten enteropathy. Only the following gluten free foods may Local Policy be prescribed: bread brown or white, sliced or unsliced but NOT fresh; Statement No. 91 bread mix; flour mix; part baked rolls, pasta NHS Stockport does not commission transoral incisionless fundoplication for the treatment of gastro-oesophageal reflux disease (GORD) owing to insufficient good quality evidence of effectiveness NHS Stockport Local Policy Statement No. 104
General Surgery
Transoral incisionless fundoplication for the Not supported treatment of gastrooesophageal reflux disease (GORD)
N/A
Specialty
Procedure
Category
Prior approval form
Policy Statement
Surgery for carpal tunnel syndrome
No
In line with the recommendation from the Greater Manchester Effective Use of Resources Group. NHS Stockport commissions surgery for carpal tunnel syndrome, following prior approval, if the patient has at least one of the following: Mild to moderate symptoms that have not responded to at NHS Stockport least 4 months of conservative measure. In pregnant women carpal tunnel Local Policy syndrome often resolves and for those women with mild to moderate Statement No. 25 symptoms to be eligible for surgery they must have not responded to at least 4 months of conservative measures post partum; or Severe symptoms including neurological deficit such as sensory loss or weakness that will not be resolved by conservative measures Surgery will not be funded in the following circumstances: 1) The ganglion is at the wrist; 2) The ganglion is on the top of the foot; 3) For seed ganglion at the base of the digits unless they are painful; 4) For mucoid cysts at the DIP joints unless they are disturbing the nail or have a tendency to discharge
Surgery for ganglion
No
Bunionectomy
No
In line with the recommendation from the Greater Manchester Effective Use of Resources Group NHS Stockport commissions bunion surgery, following prior approval, in adults that have a confirmed diagnosis of hallux NHS Stockport valgus deformity that meet both the following criteria: Conservative Local Policy treatment to manage symptoms that includes padding, appropriate Statement No. 29 footwear and analgesics or anti-inflammatory drugs has been tried for six months; and the deformity is causing either significant and persistent pain, or an obvious difficulty in walking or recurrent ulcers or recurrent infections As a stand-alone procedure IUCD insertions/ changes and removals for contraception and dysfunctional menstrual bleeding should be done out of hospital by a GP or the tier 2 service. A patient may be referred to NHS Stockport secondary care if insertion/ removal is difficult. Insertion / change of an Local Policy IUCD at the time of another procedure e.g. hysteroscopy or as part of Statement No. 186 heavy menstrual bleeding management in secondary care, is permitted in secondary care. NHS Stockport does not commission ultrasound to promote bone fracture NHS Stockport healing. In cases of delayed union where the alternative intervention is Local Policy unsuitable or has been unsuccessful ultrasound will be considered on an Statement No. 115 individual case-by-case basis. Baby milk should not be supplied in the NHS for lactose intolerance. Baby Milk should only be supplied on the NHS for the following conditions: NHS Stockport Cows milk protein intolerance; extreme sensitivity to cows milk allergen; Local Policy multiple food allergy; proven food allergy; faltering growth as evidenced on Statement no 113 a growth chart; extreme prematurity
Insertion and Removal of Inter Uterine Contraceptive Device
Group approval
N/A
Ultrasound to promote Prior approval bone fracture healing - EUR team
No
General Practice
Baby Milk
Position statement
N/a
Specialty
Procedure
Category
Prior approval form
Policy Statement
Dental
Endosseous Implants
No
NHS Stockport commissions dental implants in the following circumstances: As part of reconstructive treatment following surgery to the mouth and surrounding tissues for the treatment of malignant or other NHS Stockport Mar 2012 - The Group disease; or As part of oral and facial reconstructive treatment following Local Policy felt that this policy was severe facial trauma (two or more teeth); or For rehabilitation of patients Statement no 121 not discriminatory. with congenital defects, for example cleft palate, or multiple congenitally missing teeth (oligodontia); or Where there are severe eating or speaking disorders when wearing a conventional dental prosthesis. NHS Stockport does not commission occipital nerve stimulation for severe, NHS Stockport Mar 2012 - The Group chronic headache disorders owing to inadequate evidence of Local Policy felt that this policy was effectiveness. Statement no 123 not discriminatory. NHS Stockport only commissions unilateral or bilateral temporomandibular NHS Stockport Mar 2012 - The Group joint replacement in extreme cases with high pain scores and very limited Local Policy felt that this policy was mouth opening, where the patient is aware of the inadequate evidence of Statement no 124 not discriminatory. safety and long-term efficacy. NHS Stockport considers breast augmentation as part of gender realignment as low priority and hence does not commission NHS Stockport Local Policy Statement no 125 Mar 2012 - This would apply to M2F treatment and is similar to the gynaecomastia policy for males. The Group felt that it could potentially be discriminatory for M2F. NHS Stockport However the PCT was Local Policy not treating this group Statement no 125 any different to males with gynaecomastia or to females seeking breast reduction. Exceptional case requests can be submitted via The Individual Funding Route.
Neurology
Occipital nerve stimulation for headache
Not supported
N/A
Maxillofacial surgery
TMJ replacement
No
Psychiatry
Gender realignment breast augmentation
Not supported
No
Psychiatry
Gender realignment Not supported breast removal
No
NHS Stockport considers breast removal as part of gender realignment as low priority and hence does not commission
Specialty
Procedure
Category
Prior approval form
Policy Statement
Psychiatry
Gender realignment Not supported hair removal
No
NHS Stockport considers hair removal as part of gender realignment as low priority and hence does not commission
Mar 2012 - This would apply to M2F treatment and the Group acknowledged that there is the potential to treat this group differently to a genetic male. Hair removal for genetic NHS Stockport females is not routinely Local Policy commissioned and Statement no 125 therefore the group felt that M2F requests should be considered via the Individual Funding Route and photographs submitted to determine severity as with genetic females
Specialty
Procedure
Category
Prior approval form
Policy Statement
Psychiatry
Gender realignment Not supported speech therapy
No
Mar 2012 - This would apply to both M2F and F2M. This would not be commissioned for genetic males or females. Therefore it was felt that this policy was not discriminatory and that the policy should apply to all people and not just NHS Stockport those undergoing NHS Stockport considers speech therapy as part of gender realignment as gender realignment Local Policy low priority and hence does not commission Statement no 125 surgery. The Group advised that for patients wanting this treatment then an exceptional case request will be considered via The Individual Funding Route if normal gender realignment treatment had failed. LPS 165 has since been written to address this issue Mar 2012 - This would apply to M2F and would be considered to be NHS Stockport cosmetic. Therefore The Local Policy Group felt that this Statement no 125 policy was not discriminatory as this would not be considered for anyone.
Psychiatry
Gender realignment Not supported thyroid chrondroplasty
No
NHS Stockport considers thyroid chrondroplasty as part of gender realignment as low priority and hence does not commission
Specialty
Procedure
Category
Prior approval form
Policy Statement
Psychiatry
Gender realignment - Prior approval hysterectomy - EUR team
No
NHS Stockport does commission hysterectomy in female-to-males owing to the risk of endometrial cancer from the hormone supplementation.
Mar 2012 - This would apply to F2M and would be considered to the increased risks of cancer caused by the hormone treatments NHS Stockport given to this group of Local Policy patients. This group of Statement no 125 patients fall in to a subset of patients with a clinical risk and as this is offered to genetic females then it was thought that this policy wasnt discriminatory NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement no 150 not discriminatory.
Podiatry
Acupuncture for diabetic neuropathy
Not supported
N/A
NHS Stockport does not commission acupuncture for diabetic neuropathy owing to inadequate good quality evidence of effectiveness
Pain management
Facet Joint Injections
NHS Stockport does not commission therapeutic facet joint injections. A NHS Stockport Mar 2012 - The Group single diagnostic facet joint injection prior to radiofrequency lesioning is Local Policy felt that this policy was commissioned Statement No. 107 not discriminatory.
Pain management
Radiofrequency lesioning
Yes
General Practice
AMH testing
Not supported
No
NHS Stockport commissions radiofrequency denervation of facet joints when the following criteria are met: the patient is aged over 18 years; AND the condition has failed to respond to 12 months of non-invasive therapy NHS Stockport such as medication and physiotherapy; AND the patient experienced an Local Policy 80% reduction in pain following a diagnostic facet joint injection with local Statement No. 152 anaesthetic; AND where the patient has received a previous radiofrequency denervation at the same location they received benefit that lasted as least six months; AND the radiofrequency denervation is provided as part of a comprehensive pain management plan NHS Stockport does not commission AMH testing to check fertility. NHS NHS Stockport Stockport does not commission AMH testing for patients paying for private Local Policy IVF cycles. NHS Stockport only commissions AMH testing where required Statement No. 153 as part of the NHS IVF pathway.
Specialty
Procedure
Category
Prior approval form
Policy Statement
General Surgery
Bariatric surgery
No
NHS Stockport commissions bariatric surgery for patients with a BMI >50 or BMI between 45 and 49.9 with a serious obesity related co-morbidity (see appendix A) at first presentation who have completed an intensive weight management course provided by NHS Stockports Specialist Weight Management Team. Successful completion of the course is defined as: a minimum of 80% attendance; completion of a weekly food diary; weight loss or weight maintenance during the course and for the 6 NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was months following completion of the course; and evidence of behaviour and lifestyle change during the course and for the 6 months following Statement no 74 not discriminatory. completion of the course e.g. weight loss and increased exercise levels. The decision as to whether a patient meets these criteria will be made by the Weight Loss Surgery Panel which reports to the Individual Funding Panel. Following a referral from the Weight Loss Surgery Panel to the Bariatric Surgery service the decision to proceed with surgery, the type of surgery and the patients fitness fless they are eligible for Health Start vitamins and should not be prescr
Cardiology
Fenestrated AAA stents
No
NHS Stockport commissions fenestrated abdominal aortic aneurysm stents where the all the following criteria are met: the patient has an expected >2 year life expectancy; and the patient has an orientated mental state; and the patient has an independent quality of life; and the patient does not require dialysis; and the patient has 2 or more abnormal parameters on cardiopulmonary exercise testing which indicates a moderate or high risk of mortality with open surgery; and the diameter of the AAA is >6 cm (equating to approximately 10% per annum rupture risk); and there is <10mm straight infrarenal neck, or <15mm angulated / conical NHS Stockport Mar 2012 - The Group neck making standard EVAR unsafe; and the patient has suitable ilioLocal Policy felt that this policy was femoral access i.e. suitable for 21 F sheath access or iliac conduit and Statement no 110 not discriminatory. <60 iliac angulation; and the AAA neck angulation and visceral artery suitability are within the device manufacturers instruction for use criteria; and the patient assessment and counselling is consultant led; and the case has been discussed esponds adequately. Routine funding will then continue until the patient loses response.hotics.This also applies to vacuum pumps and constrictor rings for the treatment of erectile dysfunction. Penile prosthesis will be funded: as part of reconstructive treatment following surgery of the treatment of malignant or other diseases as part of reconstructive surgery following trauma and all non-surgical methods of treatment must previously have been exhaus
Specialty
Procedure Ketogenic diet for difficult-to-control epilepsy Height reduction surgery
Category
Prior approval form No
Policy Statement
Paediatrics
NHS Stockport commissions a ketogenic diet for difficult-to-control epilepsy, in children, on an individual patient basis
NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement no 157 not discriminatory. NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement no 155 not discriminatory.
Not supported
N/A
NHS Stockport does not commission height reduction surgery as it is considered a cosmetic procedure and hence of low priority
Dental
Removal of mercury amalgam dental fillings for the treatment of chronic fatigue Not supported syndrome (CFS) or myalgic encephalomyelitis (ME) Residential interdisciplinary management for the treatment of complex Not supported regional pain syndrome in adolescents
N/A
NHS Stockport does not commission the removal of mercury amalgam dental fillings for the treatment of chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) owing to a lack of evidence of benefit
NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement no 156 not discriminatory.
Pain management
N/A
NHS Stockport does not commission residential interdisciplinary management for the treatment of complex regional pain syndrome in adolescents owing to a lack of evidence of its superiority over out-patient interdisciplinary pain management services
NHS Stockport Mar 2012 - The Group Local Policy felt that this policy was Statement no 160 not discriminatory.
Assisted conception
Group approval
No
Referral for 1 cycle of IVF should only be made for couples meeting the following eligibility criteria at the time of referral. IVF will only be provided if these criteria are still met at the time of treatment commencement: Couples have not had a privately funded IVF cycle. Couples have failed to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology. Women are aged between 23 NHS Stockport and 39 years old at the time of treatment. Womens BMI is between 19-29. Local Policy Both partners are non-smokers. Both partners can give assurance that Statement no 170 alcohol intake is within Department of Health guidelines and they are not using recreational drugs. Childless couples are eligible. This includes new couples where only one partner has a child. Surgical sperm retrieval is commissioned where the male partner has oligospermia provided it is not as a result of a sterilisation procedure. IVF is not funded following reversal of sterilisation.
Specialty
Procedure
Category
Prior approval form
Commissioning Positition NHS Stockport does not commission reversal of sterilisation for males or females. NHS Stockport considers reversal of sterilisation to be low priority because sterilisation is provided under the NHS on the understanding that it is an irreversible procedure. Patients are informed and written consent is sought before the operation is carried out. NHS Stockport does not commission IVF following male or female sterilization or when azoospermia or oligospermia occurs following male reversal of sterilisation NHS Stockport does not commission reversal of sterilisation for males or females. NHS Stockport considers reversal of sterilisation to be low priority because sterilisation is provided under the NHS on the understanding that it is an irreversible procedure. Patients are informed and written consent is sought before the operation is carried out. NHS Stockport does not commission IVF following male or female sterilization or when azoospermia or oligospermia occurs following male reversal of sterilisation NHS Stockport does not commission speech therapy to alter voice pitch as this is considered a low priority.
Policy Statement
Reversal of Female Sterilisation
Not supported
N/A
NHS Stockport Local Policy Statement no 5
Urology
Reversal of Male Sterilisation
Not supported
N/A
NHS Stockport Local Policy Statement no 5
Sppech and Language
Speech therapy to alter voice pitch PleurX peritoneal catheter drainage system for vacuumassisted drainage of treatment-resistant, recurrent malignant ascites. Sperm washing
Not supported
N/A
NHS Stockport Apr 2012 - The Group Local Policy felt that this policy was Statement No. 165 not discriminatory.
Oncology
No
NHS Stockport commissions, on an individual case basis, PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites based on the evidence and recommendations made in NICE Medical Technology Guidance (MTG)9 NHS Stockport follows the Greater Manchester Sexual Health Network (GMSHN) commissioning guidelines for access to sperm washing for HIV+ men
NHS Stockport May 2012 - The Group Local Policy felt that this policy was Statement No. 166 not discriminatory.
Group approval
N/A
NHS Stockport Local Policy Statenment No. 197
Specialty
Procedure
Category
Prior approval form
Policy Statement
Urology
Circumcision
Group approval
N/A
Circumcision is considered a low priority treatment and will only be considered for a small number of therapeutic reasons: pathological phimosis where inability to retract the foreskin is due to permanent scarring of the preputial orifice; penile malignancy; severe recurrent attacks of balanoposthitis (inflammation of the glans and foreskin); NHS Stockport May 2012 - The Group recurrent febrile UTIs particularly with high grade ureteric reflux where Local Policy felt that this policy was circumcision would reduce further infections; tight symptomatic phimosis in Statenment No. 14 not discriminatory. over 16 year olds. Circumcision for religious, cultural or lifestyle reasons is not commissioned as it is low priority for NHS funding. Circumcision to reduce future risk of contracting conditions including penile cancer or sexually transmitted diseases (including HIV/AIDS) is not commissioned owing to a lack of evidence of clinical and cost effectiveness. NHS Stockport commissions collagenase injections for Dupuytrens contracture where the following criteria are met: the patient has a metacarpophalangeal joint contracture of 30 degrees or more; or any degree of proximal interphalangeal joint contracture; the patient has no more than two joints per hand affected; the patient has a palpable cord; and percutaneous needle fasciotomy is not suitable. NHS Stockport does not commission device-guided breathing techniques (Resperate) for the treatment of hypertension owing to inadequate evidence of benefit over other relaxation techniques
Collagenase injections for Dupuytrens contracture
Group approval
N/A
NHS Stockport Local Policy Statenment No. 162 NHS Stockport Local Policy Statenment No. 168
Device-guided breathing techniques General Practice (Resperate) for the Not supported treatment of hypertension
N/A
Replacement equipment
Not supported
N/A
NHS Stockport does not commission replacement equipment, including but not limited to BAHAs and cochlear implant speech processors, which has been lost or damaged.
June 2012 - The Group recognised that this policy was more likely to affect children, patients (including adults) with a learning disability and low income families. Hence clinicians could apply via the Individual Funding Route where exceptional cases would be considered, rather than a blanket rule applied to all
Specialty
Procedure
Category
Prior approval form
Policy Statement
Surrogacy
Not supported
N/A
NHS Stockport does not commission surrogacy as it is considered low priority.
June 2012 - The Group recognised the differential impact this decision will have on women and a restricted age range, however they felt that the decision was consistent with NHS Stockports assisted conception policy. Furthermore, the group noted that partial NHS funding for private patients would discriminate against those patients who are unable to afford the private part of the treatment, which impacts on a number of protected characteristics in the borough, particularly ethnic minority groups who are more likely to live in the deprived areas.
Paediatrics / psychiatry
Pressure devices for autism
Not supported
N/A
NHS Stockport does not commission pressure devices, such as Squease, weighted vests and Grandins Hug Machine, for the treatment of autism.
June 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of disability, but did not discriminate as the clinical evidence suggests these devices are not effective.
Specialty
Procedure
Category
Prior approval form
Commissioning Positition There is a lack of evidence that a test and treat policy improves outcomes. Testing for vitamin D is not to be requested from primary care without prior approval except where the test is being undertaken immediately after a course of high dose vitamin D to check that levels have returned to normal. In symptomatic individuals with the following, a request can be made to the EUR team for testing: Rickets, osteomalacia or symptomatic hypocalcaemia; High risk patient group with suggestive symptoms such as proximal muscle weakness or musculoskeletal aches and pains. High dose vitamin D should not be initiated in primary care for patients under the care of Stockport NHS Foundation Trust. High dose vitamin D may be initiated in primary care following a recommendation from a secondary care clinician based in a hospital other than Stepping Hill. NHS Stockport does not fund sunscreen preparations except where there is abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. NHS Stockport commissions cultivated limbal stem cell allograft for regrowth of corneal epithelium where: both eyes are affected by disease; other techniques have failed; and vision is severely affected and likely to be significantly improved if the allograft is successful
Policy Statement
General Practice
Vitamin D testing
No
Aug 2012 - The Group felt that this policy was not discriminatory.
General Practice
Sunscreen preparations
Not supported
N/A
NHS Stockport Local Policy Statenment No. 203 NHS Stockport Local Policy Statenment No. 200
Aug 2012 - The Group felt that this policy was not discriminatory. Jul 2012 - The Group felt that this policy was not discriminatory.
Ophthalmology
Cultivated limbal stem cell allograft for Prior approval regrowth of corneal - EUR team epithelium
No
Paediatrics
Hypnotherapy for Prior approval Irritable Bowel (IBS) in - EUR team children
No
Hypnotherapy for the treatment of IBS in children (under 18s) is commissioned on an individual case basis for children where all alternative, conventional treatments have failed to alleviate symptoms
NHS Stockport Local Policy Statenment No. 16a
Aug 2012 - The Group recognised that the policy had a greater impact on the protected characteristic of age, but did not discriminate as the clinical evidence suggests this intervention is less effective in adults than children
ACI for knee cartilage Not supported damage
N/A
NHS Stockport does not commission ACI, including CCI in the form of ChondroCelect, for the treatment of knee cartilage damage owing to limited evidence of additional benefit over the current standard treatment of microfracture.
Aug 2012 - The Group felt that this policy was not discriminatory.
Specialty
Procedure
Category
Commissioning Positition NHS Stockport does not commission Dermasilk clothing for eczema owing to inadequate evidence of clinical effectiveness. This policy applies for both children and adults NHS Stockport does not commission hypnotherapy for needle phobia owing to inadequate evidence of efficacy
Policy Statement NHS Stockport Local Policy Statenment No. 202 NHS Stockport Local Policy Statement No. 8a
Equality and Diversity checked Sep 2012 - The Group felt that this policy was not discriminatory Oct 2012 - The Group felt that this policy was not discriminatory
Dermatology / Dermasilk clothing for Not supported General Practice eczema Alternative / Complementary therapies Hypnotherapy for needle phobia
Not supported
N/A
General Practice
Powerbreathe
Not supported
N/A
NHS Stockport does not commission Powerbreathe for COPD owing to limited evidence of superior effectiveness compared to pulmonary rehabilitation.
Oct 2012 - The Group recognised that the policy had a greater impact on the protected NHS Stockport characteristic of Local Policy disability, but did not Statement No. 222 discriminate as the clinical evidence supports this policy decision
Paediatrics
Selective dorsal rhizotomy
No
NHS Stockport commissions an assessment for selective dorsal rhizotomy, at the Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust in Oswestry, when all the following criteria are met: the assessment is recommended by a consultant paediatrician; the child is aged 4-11 years; the child has bilateral lower limb spastic cerebral palsy; the child has lower limb strength against gravity; the child is ambulatory NHS Stockport with or without assistive devices; and there is no injury to basal ganglia Local Policy evident on an MRI. Children meeting the above criteria may not be Statement No. 154 suitable for a referral if any of the following are present: athetosis, dystonia, orthopaedic surgery within the last 6 months, chronic conditions such as bronchopulmonary dysplasia, refractory epilepsy, severe visual impairment, severe fixed joint deformities, severe scoliosis, hip dysplasia, a history of meningitis, a history of hydrocephalus unrelated to prematurity, a history of head trauma, a high BMI, poor motivation of child and/or family with regard to intensive rehabilitation required post-procedure. NHS Stockport commissions selective dorsal rhizotomy for those children found suitable for the procedure following an assessment.
Oct 2012 - The Group recognised that the policy had a greater impact on the protected characteristics of age and disability, but did not discriminate as the clinical evidence suggests this intervention is less effective in children than adults
Specialty
Procedure
Category
Prior approval form
Commissioning Positition Treatments in this section are considered LOW PRIORITY. Cosmetic treatments are not commissioned except in the following circumstances: As part of reconstructive treatment following surgery for the treatment of malignant or other disease; As part of reconstructive treatment following trauma. In exceptional circumstances and after special consideration, Stockport PCT, may allow a cosmetic treatment to proceed. These exceptional circumstances should be primarily clinical e.g. There is a significant likelihood that the individual will gain much higher than average benefit from treatment; There would be additional benefit through avoidance of social care; The patients appearance is extreme and the proposed treatment is likely to be effective.
Policy Statement
Plastic Surgery
Cosmetic
Not supported
N/A
Oct 2012 - The Group felt that this policy was not discriminatory
Autologous chondrocyte implantation (ACI) for Not supported the treatment of ankle cartilage damage
N/A
NHS Stockport does not commission autologous chondrocyte implantation NHS Stockport Oct 2012 - The Group (ACI) for the treatment of ankle cartilage damage owing to inadequate Local Policy felt that this policy was evidence of effectiveness. Statement No. 220 not discriminatory
Urology
Prosthetic testicle post- Prior approval orchidectomy - EUR team
No
NHS Stockport commissions the provision of a prosthetic testicle postorchidectomy either at the time of the orchidectomy or at a later date.
Oct 2012 - The Group recognised that the policy had a greater NHS Stockport impact on the protected Local Policy characteristic of sex, but Statement No. 219 did not discriminate as it is in line with funding of breast reconstruction post mastectomy

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EIA completed and approved by PEC June 2009.

Equality and Diversity checked

GM Evidence Review No. 8 NHS Stockport Local Policy Statement No. 46

Prior approval EUR team

Approved for use as an anti-emetic 2nd line after 5HT3.

This is not commissioned as treatment in advanced pancreatic cancer.

Equality and Diversity checked

Prior approval EUR team

Gemcitabine & Cisplatin

This is not commissioned for cholangio cancers

Prior approval Category Commissioning Positition form available

Equality and Diversity checked

This is not commissioned for metastatic breast cancer.

Pre-NICE Cancer drugs recommendations to commissioners across NWSHA 2009/10

LMWH for DVT prevention in cancer patients.

This is not commissioned.

Prior approval EUR team

Prior approval Category Commissioning Positition form available

Equality and Diversity checked

Prior approval EUR team

This is not commissioned for small call lung carcinoma.

Prior approval Category Commissioning Positition form available

Equality and Diversity checked

Anti VEGF for wet AMD

Prior approval EUR team

Procedure Infliximab for uveitis secondary to idiopathic juvenile arthritis

Equality and Diversity checked

This is commissioned on an individual patient basis

Drugs for Primary Pulmonary (arterial) Hypertension

Prior approval EUR team

Not supported Not supported Not supported

Equality and Diversity checked

Rituximab for SLE GM HCV strategy treatment guidelines for hep C

Fluconazole for thrush Not in breastfeeding supported

Siklos for Sickle Cell Crisis

Alternative / Complementary therapies

Alternative / Complementary therapies

NHS Stockport Local Policy Statement No. 73

NHS Stockport Local Policy Statement No. 78

Equality and Diversity checked

This is not commissioned for acute promyelocytic leukaemia

This is not commissioned as a first line treatment for breast cancer

This is not commissioned for glioblastoma

Equality and Diversity checked

This is not commissioned for ovarian peritoneal carcinomatosis

This is not commissioned for myelodysplastic syndrome

Docetaxel, carboplatin, Not trastuzumab (TCH) supported regimen

This is not commissioned for breast cancer

Equality and Diversity checked

Doxorubicin with microNot beads supported

Not supported Prior approval EUR team Not supported

This is not commissioned for pancreatic neuroendocrine tumours

Equality and Diversity checked

This is not commissioned for relapsed follicular lymphoma

Not supported Prior approval EUR team Not supported

Paclitaxel, albumin bound

Equality and Diversity checked

This is not commissioned for stage III malignant melanoma

This is not commissioned for Waldenstroms Macroglobulinaemia

This is not commissioned for pancreatic cancer

Equality and Diversity checked

This is not commissioned for low grade gliomas

Policy Statement NHS Stockport Local Policy Statement No. 81

Equality and Diversity checked