The Evidence-Based Interventions (EBI) policy aims to reduce unnecessary medical procedures and prevent avoidable harm to patients by making sure that treatments routinely available on the NHS are appropriate and clinically effective. The EBI policy will ensure that people who would benefit from one of these ‘traditional’ procedures are offered them but for most people, there is a safer and less invasive alternative.
To gather people’s views on this policy, NHS England carried out a public consultation from 4 July to 28 September 2018. The EBI policy received a significant amount of support from patient organisations, commissioners, providers and other representative bodies, demonstrating strong support for its main objectives - to reduce variation and support clinicians to follow best practice.
After consideration and approval through the Partnership’s Improving Planned Care programme, the Joint Committee has agreed to adopt the policy in the nine Clinical Commissioning Groups (CCGs) across West Yorkshire and Harrogate. By having a standard approach to EBI throughout West Yorkshire and Harrogate, we can avoid the perceived ‘postcode lottery’ by reducing variation and health inequalities.
EBI guidance includes the following four interventions that should no longer be routinely offered on the NHS because they do not work in the vast majority of cases, or because they have been replaced by a safer and less invasive alternative:
A. snoring surgery (where the person does not have obstructive sleep apnoea (OSA);
B. dilatation and curettage (D&C) for heavy menstrual bleeding;
C. knee arthroscopy (keyhole surgery) for patients with osteoarthritis; and
D. injections for non-specific low back pain where the person does not have sciatica.
There may be rare occasions when one of these four interventions would be appropriate and beneficial for a patient. In such circumstances, the treatments can be offered if accompanied by a successful Individual Funding Request (IFR) made on behalf of the patient by their clinician. You’ll find more details about the IFR process on your local CCG’s website.
The following thirteen interventions also included in the EBI guidance are only appropriate in certain circumstances. These treatments will only be offered to patients when specific clinical criteria are met, if symptoms do not resolve after an alternative or less invasive treatment for example.
E. breast reduction;
F. removal of benign (harmless) skin lesions;
G. grommets for glue ear in children;
H. tonsillectomy for recurrent tonsillitis;
I. haemorrhoid surgery;
J. hysterectomy for heavy menstrual bleeding;
K. chalazia (eyelid cyst) removal;
L. shoulder decompression;
M. carpal tunnel syndrome release;
N. Dupuytren’s contracture (curling of the fingers) release;
O. ganglion cyst removal;
P. trigger finger release (difficulty bending a finger or thumb); and
Q. varicose vein surgery.
Every health condition has a plan called a ‘clinical pathway’ that sets out the various steps in the care of people referred for treatment by their GP or other health professional. For patients on one of these pathways, there are various points at which decisions are made about their care. These points on a pathway are known as ‘clinical thresholds’ and are used to decide which treatments will be provided and funded by the NHS to provide the best care for patients.
In West Yorkshire and Harrogate, there are unnecessary differences in some of these clinical thresholds. This means that some people may be receiving different treatments depending on where they live. Once the EBI policy is implemented by all nine CCGs from April 2019, the clinical thresholds for the interventions listed above will be the same for everyone across the region. Documents that detail the clinical thresholds for each of these 17 interventions can be viewed here. You'll also find links to patient information about each intervention, and other resources that you may find useful.
For some areas, there will be no difference to the current situation but this standardisation will result in some differences for other areas. This could be that more people become eligible for the treatments, or it could be that fewer people will be eligible. This EBI ‘mapping and gapping’ document details the current situation for all nine CCGs and what the differences will be once the new EBI policy is in place. As detailed in this document, not all CCGs currently have policies in place for some of the interventions. In most cases this is because the number of times that the particular intervention is carried out in that area is so low that there has been no need to put a formal decision making process in place.
In West Yorkshire and Harrogate, around 16,700 EBI procedures are carried out every year and it’s estimated that this figure will fall to below 10,000 under this new policy. By not carrying out such procedures, capacity and resources can be freed up for other things that have been proven to work effectively. The potential efficiency savings of around £9 million would be reinvested to provide appropriate treatments and interventions that provide better outcomes for patients.
NHS England has produced a short introduction to the Evidence-Based Interventions programme featuring lead spokespeople from each of the programme partners. Click on the image to view the film.