Policies & Funding Information – Berkshire East

Cosmetic, Other Surgeries, Devices, Screening, Diagnostics and Other Therapies
Information and forms can be found by using the search facility on the right of the table below (just above Process Pathway). Type a word associated with the intervention you require and a limited list of policies and forms to be displayed. For example Assisted Conception would be displayed if any of the following is typed Assisted, Conception, IVF.

Fully completed application forms should be saved locally and sent from a secure NHS.net account to BerksEast.IFRrequests@nhs.net for consideration.

INTERVENTIONPOLICY STATEMENTPROCESS PATHWAY
Acupuncture for the treatment of chronic, non-specific low back pain
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and funding approval must always be obtained from the IFR service prior to referral and treatment.

For these cases a strong case on grounds of exceptional health need must be provided. The GP must fully complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
Email the completed form to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Acupuncture
Procedure Not Routinely Funded
BPC 17
17 Acupuncture
This procedure is not routinely funded and funding approval must always been obtained prior to referral and treatment.

If there is exceptional health need the GP must obtain funding from the IFR service by fully completing the following:
General Funding Form
and emailing it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Adenoidectomy
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC20 Surgical Management of Otitis Media with effusion in children (under the age of 12 years)
Adjuvant adenoidectomy in the absence of persistent and/or frequent upper respiratory tract symptoms is a low priority, and will not normally be commissioned
This procedure always requires prior approval from the IFR service.

If after assessment, the Consultant wishes to treat, they must apply for prior approval by either fully completing the following
Adenoidectomy with Grommets Application Form
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at https://www.england.nhs.uk/rightcare/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.

ADHD Treatment Pathway for Adults with Attention Deficit Hyperactivity Disorder
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC71 Treatment pathway for adults with attention deficit hyperactivity disorder (ADHD) - November 2017
NEW
This procedure is funded subject to audit. Please refer your patient direct by Electronic Referral System if they fully meet the criteria outlined in the policy.

If the criteria are not fully met, prior to referral and treatment, please check with our referral triage service that the patient is eligible by fully completing the following:
General Funding Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Adhesive Capsulitis (Frozen Shoulder)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC74 Adhesive Capsulitis (Frozen Shoulder) - January 2018
NEW
This procedure always requires prior approval from the IFR service.

If after assessment, the Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
Adhesive Capsulitis Form
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Aesthetic/Cosmetic Breast Surgery including:
breast augmentation, revision of breast augmentation, breast asymmetry, revision of breast augmentation, breast mastopexy - breast lift, mammoplasty, reconstruction /revision of breast (not including post breast cancer), inverted nipple, removal of supernumerary nipples
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Aesthetic Breast Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Breast Surgery including:
corrective surgery to nipple (excluding cancer)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure always requires prior approval from the IFR service. If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please complete fully the following:
Breast Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Breast Surgery:
- breast implant removal and replacement
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure always requires prior approval from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please complete fully the
Breast Implant Removal and Replacement Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Breast Surgery:
- female breast reduction, reduction mammoplasty
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the
Breast Reduction Form - Female
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Breast Surgery:
- male breast reduction for gynaecomastia
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the
Breast Reduction Form - Male
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Benign skin lesions and lipomata including:
Acne vulgaris, Dermatofibromas (skin growths), Naevi (benign pigmented naevi, epidermal, haemangioma, moles, spider, congenital and port-wine, Onychomycosis (fungal nail infections), Rhinophyma, Rosacea, Scars including keloid (removal and revision), Sebaceous cysts (pilar and epidermoid cysts), Seborrhoeic keratosis (benign skin growths, basal cell papilloma, senile warts), Skin tags, Tattoo (removal or revision), Telangiectasia (HHT, spider veins and thread veins), Vitiligo, Warts (plantar including verrucae, filiform and common), Xanthelasmas (cholesterol deposits underneath the skin) (excluding ?histology ie cancer), Lipoma and Lipomata (fat deposits underneath the skin)
Laser removal of skin lesions, haemangioma, congenital naevi
Excluding BCC and SCC
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following checklist:
Lesions Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need.

Please email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Excess skin removal and body contouring including but not limited to:
abdominoplasty, apronectomy, (tummy tucks), reconstruction/revision of body (excess skin removal for all areas, reconstruction/revision of body (excess skin removal all areas) post bariatric surgery/ weight loss,
body contouring procedures (buttock, thigh, arm lifts, calf implants), plastic operations on umbilicus, brachioplasty (arm lifts), liposuction, facial procedures including eye bags, facelift (rhytidectomy/ surgical removal of wrinkles)/ brow lift and submental lipectomy
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Excess Skin Removal Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Excision of skin tag of anus (not including fistula's)
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure is funded subject to audit. Please refer your patient directly by the electronic referral service if they fully meet the criteria outlined in the policy.

If the Consultant wishes to treat and the patient does not fully meet the criteria then prior approval is always required from the IFR service prior to treatment. Please complete the following:
Lesions Form
or provide detailed clinical letters which clearly indicate how the policy criteria are met.
Please email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Eyelid surgery (blepharoplasty) including
blepharoptosis (an abnormal low-lying upper eyelid margin) and dermatochalasis (skin redundancy of the upper lid)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Eyelid Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
including:
Removal chalazion (meibomian cysts)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure always requires prior approval from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please complete fully the following:
Eyelid Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Nose reshaping including
Rhinoplasty / Septorhinoplasty (cosmetic nose surgery), Reconstruction/revision surgery
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Nose Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Aesthetic/Cosmetic Procedures
Other procedures including:
botox for cosmetic reasons, pinnaplasty for adults and children (bat ears), reconstruction /revision of external ear, split earlobes, meatoplasty/plastic operations on external ear (lobe repair),
irregularities of aesthetic significance,
excision of sweat bearing glands,
laser treatment, excessive hirsutism,
minor skin procedures (not including BCC and SCC),
aesthetic/cosmetic genital surgery (male or female), clitoroplasty, labiaplasty, vaginoplasty, hymenopathy,
penile prosthesis / enlargement,
repair of traumatic /chronic clefts due to avulsion of body piercing,
skin resurfacing (dermabrasion, laser and chemical peels),
correction of Alopecia (hair loss including Intralace), correction of male pattern baldness, hair transplantation, hair grafting, intralace
treatments for hirsutism/ hair depilation, electrolysis for hair removal
appliances and devices for cosmetic purposes (high-grade silicon cosmesis and/or prosthesis)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Aesthetic/Cosmetic General Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Anal Irrigation Systems for the Management of Faecal Incontinence/ConstipationThames Valley Priorities Committee Commissioning Policy Statement
TVPC3a policy recommendation Anal Irrigation Systems for the Management of Faecal Incontinence/Constipation - October 2014
Please follow the recommended care pathway.
Anti-VEGF treatments and dexamethasone implants for macular oedema caused by central and branch retinal vein occlusion
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC5 Anti-VEGF treatments and dexamethasone implants for macular oedema caused by central and branch retinal vein occlusion - July 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Anti-VEGFs for sight-threatening eye conditions other than 'wet' age related macular degenerationBPC
160 Anti-VEGFs for sight-threatening eye conditions other than 'wet' age related macular degeneration - October 2009
Arthroscopic Lavage and Debridement for Patients with Osteoarthritis of the knee
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC6 Arthroscopic lavage and debridement for patients with osteoarthritis of the knee - July 2016
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of exceptional health need must be provided. Please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Assisted Conception Services (including IVF/ICSI for infertile couples)
Procedure that requires Prior Approval

TV 11g
11g Assisted reproduction services for infertile couples - November 2013, updated November 2017
NEW
Appendix to Policy Statement 11g
Summary of the rationale behind departing from NICE guidelines
Patients/couples requesting specialist infertility treatment and meeting the eligibility criteria must be referred for specialist infertility treatment(s) by a NHS Consultant Gynaecologist.
Please complete the following:
Assisted Reproduction Services Form
and submit it to the tertiary provider of the patient’s choice.
Current designated (approved) specialist fertility centres in the Thames Valley are:
Oxford Fertility Unit
Care Northampton
Nuffield Woking

If the patients/couples do not meet the criteria then the Assisted Reproduction Services Form should be completed detailing how the couple are clinically exceptional. Please email the completed form to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient leaflet - Assisted Reproduction Policy - Nov 2013

Please note: Immigration health surcharge; removal of assisted conception services (Legislation.gov.uk)
Amendments to the NHS (Charges to Overseas Visitors) Regulations 2015 were introduced into Parliament on 19 July 2017. As a result, from 21 August 2017, assisted conception services will no longer be included in the scope of services available for free for those who pay the immigration health surcharge. It is therefore important that to ensure potential users of these services are aware of the changes.

Consultants must ensure that funding is in place prior to treatment.
Atomoxetine in Adults with Attention Deficit Hyperactivity Disorder (ADHD)MOBBB
15 Atomoxetine in Adults with ADHD - July 2010
Autologous blood injections and Platelet rich plasma injections
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC57 Autologous blood injections and Platelet rich plasma injections - May 2017
NEW
This procedure is not routinely funded and funding approval must always be obtained from the IFR service prior to referral and treatment.

For these cases a strong case on grounds of exceptional health need must be provided. Please fully complete the following form clearly detailing the exceptionality:
Exceptional Circumstances Submission Form
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Autologous Cartilage TransplantationNHS EnglandFollow the appropriate pathway. For further information contact NHS England
Biologic therapy in Ophthalmology - Sequential useThames Valley Priorities Committee Commissioning Policy Statement
TVPC45 Sequential use of biologic therapy in Ophthalmology - November 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Biologic therapy in Psoriatic Arthritis - Sequential useThames Valley Priorities Committee Commissioning Policy Statement
TVPC46 Sequential use of biologic therapy in Psoriatic Arthritis - November 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Biologic therapy in Rheumatoid ArthritisThames Valley Priorities Committee Commissioning Policy Statement
TVPC51 Sequential use of biologic therapy in Rheumatoid Arthritis - May 2017
NEW
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Biologic therapy in Sequential use of a third or subsequent biologic - Sequential useThames Valley Priorities Committee Commissioning Policy Statement
TVPC44 Sequential use of a third or subsequent biologic therapy for psoriasis - November 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Biological disease modifying drugs in rheumatoid arthritis in adultsMOBBB
45b Biological disease modifying drugs in rheumatoid arthritis in adults - June 2012
Biological Mesh
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC14 Biological Mesh - August 2015 BE
This procedure requires prior approval prior to treatment.

If the Consultant wishes to treat, prior approval must be obtained from the IFR service by either fully completing the following:
General Funding Form
or sending detailed clinic letters which clearly outline how the patient meets the criteria by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Biological therapies for ulcerative colitis in adults
(18 years and over)
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC43 Use of biological therapies for ulcerative colitis in adults - August 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Blepharoplasty
- upper and lower lid surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
This procedure always requires prior approval from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please complete fully the following:
Eyelid Surgery Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need.

Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Bone Anchored Hearing AidsNational Policy
NHS England
Bone anchored hearing aids - April 2013
For further information contact NHS England
Botulinum toxin Type A (Botox) - Chronic Anal Fissure
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Botulinum toxin Type A (Botox) - chronic headaches (excluding migraines)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.

TA 260
Botulinum Toxin Type A for the prevention of headaches in adults with chronic migraine
Botulinum toxin Type A (Botox) - Hyperhidrosis (Excessive sweating)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC25 Hyperhidrosis (Excessive Sweating) - Botulinum Toxin and Endoscopic Thoracic sympathectomy
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Botulinum Toxin Type A (Botox) - Long term Bell's Palsy
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Botulinum toxin Type A (Botox) - Overactive Bladder
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure requires prior approval from the IFR service.

If after assessment the Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which clearly outline how the patient meets the criteria to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Botulinum toxin Type A (Botox) - Sialorrhoea (Severe Drooling)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Botulinum toxin Type A (Botox) - Spasticity
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC12 Botulinum Toxin A
This procedure requires prior approval.

If after assessment the Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which clearly outline how the patient meets the criteria to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Cannabinoids in the Management of Multiple Sclerosis and Chronic PainBPC
147 Cannabinoids in the Management of Multiple Sclerosis and Chronic Pain - March 2009
Carotid Endarterectomy and Endovascular StentNational Policy
NHS England
Complex Endovascular Stent Grafts in Abdominal Aortic Aneuruysm - April 2013
For further information contact NHS England
Carpal Tunnel Syndrome
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC19 Carpal Tunnel Syndrome
This procedure requires prior approval from the IFR service prior to referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from IFR service by either fully completing the following:
Carpal Tunnel Syndrome Form
or sending detailed clinic letter(s) which outlines clearly how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at
https://www.england.nhs.uk/rightcare/useful-links/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.
Cataract removal in adults (including second eye cataract surgery) threshold referral for surgery
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC60 Cataract Removal in Adults - Threshold for Surgery - August 2017
This procedure is funded subject to audit. Please refer your patient directly by the electronic referral service if they fully meet the criteria outline in the policy.

If the Optometrist wishes to refer the patient but they do not fully meet the criteria, prior approval is always required from the IFR service. Please fully complete the following:
Cataract Form
Email the fully completed form and any supporting evidence to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Cerebellar Stimulator ImplantsNHS EnglandFor further information contact NHS England
Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME) inpatient stay
Procedure Not Routinely Funded
BPC 130
130 Chronic Fatigue Syndrome
In the first instance the patient should be referred into local CBT service.

Inpatient and outpatient treatment are not routinely funded and prior approval is always required prior to referral and treatment.

If the GP wishes to refer there must be a strong case on the grounds of an exceptional health need. If there is an exceptional health need for treatment please complete the following:
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Closure of patent foramen ovale for migraine (PFO)National Policy
NHS England
Patent Foramen Ovale PFO Closure - April 2013

For further information contact NHS England
Complex Neurological Rehabilitation for acquired brain injury not including injury due to strokeRehabilitation Categories:
Rehabilitation Categories BE
Rehabilitation Categories:
Please complete all the following forms:

1 Complex Neurological Rehabilitation Needs
2 The Rehabilitation Complexity Scale - Trauma (RSCE-Trauma)
3 Complex Neurological Rehabilitation Referral
Complex Neurological Rehabilitation - referral forms
Please email the completed forms to the IFR service at BerksEast.IFRrequests@nhs.net
Continuous subcutaneous insulin infusion (insulin pumps) for adults with type 1 diabetes
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC65 Continuous subcutaneous insulin infusion (insulin pumps) for adults with type 1 diabetes - April 2018
NEW
This device is funded subject to audit if the criteria outlined in the policy are fully met.
Contribution to Reimbursement of Expenses for Living Donors (Renal Transplantation)National Policy
NHS England
Reimbursement of Expenses for Living Kidney Donors - April 2013
For further information contact NHS England
Coronary Artery StentsNHS EnglandFor further information contact NHS England
Correction of Ptosis
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC16 Aesthetic Treatments for Adults and Children - Updated August 2017
NEW
Prior approval is always required from the IFR service before referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please fully complete the appropriate checklist:
Eyelid Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Corticosteroid injections for lateral elbow tendinopathy (tennis elbow)MOBBB 65
65a Corticosteroid injections elbow
This procedure is not routinely funded and is considered low priority. If there is exceptional health need please fully complete the following:
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Corticosteroid injections for patellar tendinopathy (jumper’s knee)MOBBB 66
66 Corticosteroid injections patellar
This procedure is not routinely funded and is considered low priority. If there is exceptional health need please fully complete the following:
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Cryopreservation - preservation of fertility (Male and Female)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC17 Policy for the preservation of fertility - July 2016
Prior approval is always required from the IFR service before referral and treatment. The NHS Fertility Service or the Consultant wishing to treat, should fully complete the following:
Preservation of Fertility Form
or provide detailed clinical letters which clearly indicate how the policy criteria are met.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Cryotherapy (salvage) for recurrent prostate cancerNHS England
For further information contact NHS England
Cryotherapy for localised Prostate cancerNHS EnglandFor further information contact NHS England
Deep Brain Stimulation for Parkinson’s DiseaseNational Policy
NHS England
Deep Brain Stimulation DBS in movement disorders - April 2013
For further information contact NHS England
Deep Brain Stimulation for primary dystonia and essential tremorNational Policy
NHS England
Deep Brain Stimulation DBS in movement disorders - April 2013
For further information contact NHS England
Deep Brain Stimulation including other interventionsNational Policy
NHS England
DBS for Indications except movement disorders - April 2013
For further information contact NHS England
Dental ImplantsNHS EnglandFor further information contact NHS England
Dilatation and curettage (D&C) for abnormal uterine bleeding
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC29 Dilatation and curettage (D&C) for abnormal uterine bleeding - April 2018
NEW

Medicines & Healthcare product Regulatory Agency (MHRA)
9 February 2018 – New temporary safety measures introduced for Esmya following reports of serious liver injury in women using the medicine for uterine fibroids.
Esmya (ulipristal acetate) for uterine fibroids: monitor liver function in current and recent users; do not initiate treatment in new users or those between treatment courses.
MHRA Safety Alert - 9 February 2018
NEW
This procedure is not normally funded.

If there is exceptional health need the Consultant must obtain funding from the IFR service by fully completing the following:
General Funding Form
or provide detailed clinic letter(s) that clearly outline how the patient meets criteria for consideration and the exceptional health need.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Disc replacement surgery
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017

This procedure is not routinely funded and prior approval is always required from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, and there is exceptional health need please fully complete the following form and demonstrate the exceptional health need:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Donepezil, galantamine, rivastigmine and for the treatment of dementia associated with Parkinson's disease of Lewy BodiesBPC
146 Donepezil , galantamine, rivastigmine for the treatment of dementia associated with Parkinson's disease or Lewy Bodies (AChEIS) - February 2009
Donepezil, galantamine, rivastigmine and mematine for the treatment of Alzheimer's diseaseBPC
11b Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (AChEIS)- updated Februrary 2009
Dupuytren’s Contracture
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC18 Dupuytrens contracture - October 2017
This procedure requires prior approval from the IFR service prior to referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Dupuytrens Form
or by sending detailed clinic letter(s) which outline clearly how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Ectropion and Entropion - indications for surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC70 Ectropion and Entropion - indications for surgery - November 2017
This procedure requires prior approval from the IFR service prior to referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Eyelid Surgery Form
or by sending detailed clinic letter(s) which outline clearly how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Eflornithine for facial hirsutism (Vaniqa© Cream)
Procedure Not Routinely Funded
BPC 88
88 Eflornithine for facial hirsutism
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
General Funding Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration an dthe exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Elective Endovascular repair infrarenal abdominal aortic aneurysmsNational Policy
NHS England
Complex Endovascular Stent Grafts in Abdominal Aortic Aneuruysm - April 2013
For further information contact NHS England
Eligibility for NHS transport for patients in non-emergency situationsBPC 68
68 Eligibility for NHS Transport

As per the policy.
Endoscopic Thoracic Sympathectomy for Facial Blushing and/or sweating
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC25 Hyperhidrosis (Excessive Sweating) - Botulinum Toxin and Endoscopic Thoracic sympathectomy
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on the grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
Exceptional Circumstances Submission Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Epidural injections for acute and severe sciatica - Diagnostic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017

This is a procedure not routinely funded and prior approval is always required from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, and there is exceptional health need please fully complete the following form and demonstrate the exceptional health need:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration for consideration.

Consultants must ensure that funding is in place prior to treatment.

Epidural injections for neurogenic claudication in people who have central spinal canal stenosis are not normally funded.
Epidural injections for acute and severe sciatica - Therapeutic
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017

This procedure always requires prior approval from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, please fully complete the following:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration for consideration.

Consultants must ensure that funding is in place prior to treatment.

Epidural injections for neurogenic claudication in people who have central spinal canal stenosis are not normally funded.
Erectile Dysfunction treatments
Including: Alprostadil cream, Erectile pumps/devices and psychosexual interventions
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC34 Erectile Dysfunction - updated July 2017
These treatments are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

For these requests a strong case on grounds of exceptional health need must be provided. Please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the case and the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Erectile Dysfunction treatments
Including: the drugs sildenafil, vardenafil, tadalafil and avanafil and prostaglandin E1 intracavernosal injections and intraurethral instillations
Procedure Funded Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC34 Erectile Dysfunction - updated July 2017
Prior approval is not required where the patient meets the criteria in full for the listed drugs.

If the Consultant wishes to treat and the patient does not fully meet the criteria then prior approval is always required from the IFR service prior to treatment. Please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinical letters which clearly indicate how the policy criteria are met.
Please email the completed form/letters to the IFR service BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Excess Treatment Costs (ETCs) for non-commercial clinical trials
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC37 Excess Treatment Costs (ETCs) for non-commercial clinical trials - July 2016
These are not routinely funded and prior approval must always be obtained.
Facet Joint Injections & Medial Branch Blocks for chronic neck pain - Diagnostic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC56 Facet joint injections and medial branch blocks for chronic neck pain - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.
If the GP to refer to secondary care or a Consultant wishes to treat, they must always apply for prior approval to the IFR service. Please complete the following:
Facet Joint Injection for Neck Pain Form
and email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Facet Joint Injections & Medial Branch Blocks for chronic neck pain - Therapeutic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC56 Facet joint injections and medial branch blocks for chronic neck pain - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.
If the GP wishes to refer to secondary care or a Consultant wishes to treat, they must always apply for prior approval to the IFR service. Please complete the following:
Facet Joint Injection for Neck Pain Form
and email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Facet Joint Injections & Medial Branch Blocks for low back pain - Diagnostic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

For these cases a strong case on grounds of exceptional health need must be provided. If the GP wishes to refer to secondary care or a Consultant wishes to treat, please complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
or provide detailed clinic letters which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Facet Joint Injections & Medial Branch Blocks for low back pain - Therapeutic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

For these cases a strong case on grounds of exceptional health need must be provided. If the GP wishes to refer to secondary care or a Consultant wishes to treat, please complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
or provide detailed clinic letters which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Female Pelvic Organ Prolapse
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC59 Management of Female Pelvic Organ Prolapse - August 2017
This procedure always requires prior approval from the IFR service.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
Female Pelvic Organ Prolapse Form
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria.

Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultant must ensure that funding is in place prior to treatment.
Female sterilisation
Procedure Not Routinely Funded

Thames Valley Priorities Committee Commissioning Policy Statement
TVPC68 Female Sterilisation - November 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service.

If the Gynae service wishes to refer for treatment or the Consultant wishes to treat, they must have prior approval from the IFR service. Please either fully complete the following:
General Funding Form
or provide detailed clinic letter(s) that clearly outline how the patient meets criteria.
Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Femoro-acetabular (Hip) Impingement (Arthroscopic and open Approaches) – Surgical Treatment - Hip Impingement surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC33 Surgical treatment of fermoro acetabular hip impingement (FAI) (open or arthroscopic) - July 2016
These procedures always require prior approval from the IFR service prior to referral and treatment in secondary care.

If the GP or the MSK service wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained.
Please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

In reference to TVPC33 Policy statement for Hip Impingement Surgery and prior approval process agreed providers and referral contacts are:
Frimley Health NHS Foundation Trust Hospitals (Frimley Park, Heatherwood and Wexham Park Hospitals): Mr Jonathan Hull and Mr Sebastian Sturridge
Royal Berkshire NHS Foundation Trust, Reading: Mr Tom Pollard and Mr Tony Andrade
Nuffield Orthopaedic Centre, Oxford: Mr Sion Glyn-Jones
Buckinghamshire Healthcare NHS Trust: Mr Gurdeep Biring
Basingstoke and North Hampshire Hospital: None

Consultants must ensure that funding is in place prior to treatment.
Fenestrated endovascular stent-grafts for abdominal aortic aneurysmsNHS EnglandFor further information contact NHS England
Foetal Alcohol Specturm Disorders (FASD) in children, adolescents and adults
- diagnosis and treatment (other than locally commissioned services)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC77 The diagnosis and treatment of Foetal Alcohol Spectrum Disorders (FASD) in children, adolescents and adults - April 2018
NEW
There are locally commissioned services within Mental Health, Learning Disability and Neurology which are able to identify and treat the difficulties associated with FASD.

Due to this, national specialist assessment and treatment programmes solely for the diagnosis and treatment of FASD in children, adolescents and adults are not normally funded.

Where such referral and treatment is requested a strong case on grounds of exceptional health need must be provided. Prior to referral and treatment the GP should complete the following form and clearly detail the exceptionality:
General Funding Formand email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Functional Electrical Stimulation (FES) for Upper and Lower Limb Dysfunction of Central Neurological Origin
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC62 Functional Electrical Stimulation (FES) for Upper and Lower Limb Dysfunction of Central Neurological Origin - October 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat a strong case on the grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
Exceptional Circumstances Submission Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Functional endoscopic or sinus surgery, surgery in the management of chronic rhinosinusitis(CRS) and nasal polyposis(NP) (FESS)
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC21 Rhinosinusitis
This procedure is funded subject to audit. Please refer you patient directly by the e-Referral Service if they fully meet the criteria outlined in the policy.

If the Consultant wishes to treat and the patient does not fully meet the criteria then prior approval is always required from the IFR service prior to treatment. Please complete the following:
General Funding Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Gallstones
- management of asymptomatic gallstones
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC75 Management of asymptomatic gallstones - April 2018
This procedure is funded subject to audit. Please refer your patient directly by the electronic referral service if they fully meet the criteria outline in the policy.

If the Consultant wishes to treat and the patient does not fully meet the criteria then prior approval is always required from the IFR service prior to treatment. Please complete the following:
Gallstones Form
or provide detailed clinical letters which clearly indicate how the policy criteria are met.
Please email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Gamma Knife Surgery for Trigeminal NeuralgiaNHS EnglandFor further information contact NHS England
Ganglion (including Ganglion of the wrist)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC15 Ganglion Cysts
This procedure always requires prior approval from the IFR service in secondary care.

If the GP or MKS service wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please fully complete the following:
Ganglion Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Gender Reassignment surgery for the treatment of Gender DysphoriaNational Policy
NHS England
Interim Gender Dysphoria Protocol and Service Guidelines 2013/14

Thames Valley Priorities Committee Commissioning Statement
TVPC2 policy recommendation Gender Dysphoria October 2014
Patients should be referred to a specialist centre in line with the NHS England National Policy and Thames Valley policy recommendations.

TVPC2 GP referral information for Gender Dysphoria Services October 2014
Grazax® allergy vaccine for seasonal rhinitisBPC
109 Grazax® allergy vaccine for moderate to severe seasonal rhinitis (grass pollen hay fever) - April 2007
Haemorrhoids
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC72 Management of Haemorrhoids - January 2018
NEW
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Haemorrhoids Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hallux Valgus (Bunions) - Surgery for painful big toe
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC47 Surgery for painful big toe (bunion) - November 2016
This procedure requires prior approval from the IFR service before referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Bunion Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hemicraniectomy for malignant middle cerebral artery infarctionNHS EnglandFor further information contact NHS England
Hernia (abdominal/ventral)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Hernia Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hernia (Epigastric)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Hernia Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hernia (Femoral, Spigelian or Inguino-scrotal)
Prior Approval not required
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
This procedure is funded subject to audit.

Please refer your patient directly for surgical opinion for patients with the following conditions where prior approval for surgery is not required:
- diagnosis of femoral hernia
- diagnosis of Spigelian hernia, following ultrasound confirmation
- diagnosis of an inguino-scrotal hernia
Hernia (Incisional)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Hernia Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hernia (Inguinal)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Hernia Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at:
https://www.england.nhs.uk/rightcare/useful-links/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.
Hernia (Umbilical, Para-umbilical)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC48 Elective surgical hernia repair in adults - November 2017
Prior approval is always required from the IFR service before referral and treatment in secondary care.

If the GP wishes to refer to secondary care they must always apply for prior approval from the IFR service. Please fully complete the following:
Hernia Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
High-intensity focused ultrasound for colorectal liver metastasesMOBBB 76
76 High-intensity focused ultrasound for colorectal liver metastases
For further information contact NHS England
Hip and Knee Replacement Surgery - follow up appointment
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC8 Routine follow-up after primary hip and knee joint replacement surgery - July 2016
Follow the appropriate pathway as outlined in the policy.

Prior approval is always required for further appointments following the initial routine follow-up appointment.

Prior to referral the GP must obtain approval from the IFR service by either fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which outline clearly how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hip joint revision surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC55 Primary hip and knee replacement revision surgery - March 2017, updated January 2018
NEW
Prior approval is always required from the IFR service before referral to secondary care.

If the GP/Consultant wishes to treat, they must always apply for prior approval to the IFR service. Please fully complete the following:
Primary Hip or Knee Replacement Revision Surgery Form
and email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hip ProsthesesNICE TA 304
NICE TA 304 states that prostheses for total hip replacement and resurfacing arthroplasty are recommended as treatment options for people with end-stage arthritis of the hip only if the prostheses have rates (or projected rates) of revision of 5% or less at 10 years. This recommendation supersedes the previous prosthesis policy discussing the types of prosthesis used in THR.
Hip Resurfacing for Advanced ArthropathyNICE TA 304
NICE TA 304 states that prostheses for total hip replacement and resurfacing arthroplasty are recommended as treatment options for people with end-stage arthritis of the hip only if the prostheses have rates (or projected rates) of revision of 5% or less at 10 years. This recommendation supersedes the previous prosthesis policy discussing the types of prosthesis used in THR.
Homeopathy - Complementary therapy

- body massage, hypnosis
Procedure Not Routinely Funded
BPC 10
10 Homeopathy
This procedure is not routinely funded and funding approval must always been obtained prior to referral and treatment.

If there is exceptional health need the GP must obtain funding from the IFR service by fully completing the following:
General Funding Form
and emailing it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Hysterectomy (excludes Cancer)
Procedure that requires Prior Approval

Thames Valley Priorities Committee Commissioning Policy Statement
TVPC58 Hysterectomy - indications for surgery - April 2018

Medicines & Healthcare product Regulatory Agency (MHRA)
9 February 2018 – New temporary safety measures introduced for Esmya following reports of serious liver injury in women using the medicine for uterine fibroids.
Esmya (ulipristal acetate) for uterine fibroids: monitor liver function in current and recent users; do not initiate treatment in new users or those between treatment courses.
MHRA Safety Alert - 9 February 2018
NEW
This procedure always required prior approval.

If the Consultant wishes to treat they must have prior approval from the IFR service. Please either fully complete the following:
Hysterectomy Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets the criteria.
Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Impacted Third Molars - Wisdom Teeth
NHS EnglandFor further information contact NHS England
Implantable Cardioverter Defibrillator devices for non-ischaemic cardiomyopathyNHS England
For further information contact NHS England
Implementation of NICE Interventional Procedures Guidance (IPGs), Medical Technologies Guidance (MTGs) and Diagnostic Technologies Guidance (DTGs)
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC41 Implementation of NICE IPGs, MTGs and DTGs - July 2016
These are not routinely funded and prior approval must always be obtained.
Inpatient pain management programmes for adults with chronic painNHS EnglandFor further information contact NHS England
Interventions for non-union fracture: Low-intensity Pulsed Ultrasound (marketed in the UK as the Exogen® system) and teriparatide
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC10 Interventions for non-union fracture: Low-intensity Pulsed Ultrasound (marketed in the UK as the Exogen® system) and teriparatide - July 2016
Prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat approval must be obtained from the IFR service by either fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which clearly outline how the patient meets criteria and the health. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Intracranial Aneurysms – treatment of incidentally discovered IAsNational Policy
NHS England
Flow Diverting Device for Intracranial Aneurysms - April 2013
For further information contact NHS England
Intrathecal Baclofen pumps for severe spascityNational Policy
NHS England
Intrathecal Baclofen - April 2013
For further information contact NHS England
Intravenous versus oral steroids for exacerbations of multiple sclerosisMOBBB
67 Intravenous versus oral steroids for exacerbations of mulitiple sclerosis - v2 - January 2012
Ketone TestingThames Valley Priorities Committee Commissioning Policy and Care Pathway
TVPC13 Ketone Testing

Please follow the recommended pathway
Knee Arthroscopy for Meniscal Tears
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC76 Knee Arthroscopy for Meniscal Tears - April 2018
NEW
This procedure always requires prior approval from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval from the IFR service must be obtained. Please complete fully the
Knee Arthroscopy Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Knee joint revision surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC55 Primary hip and knee replacement revision surgery - March 2017, updated January 2018
NEW
Prior approval is always required from the IFR service before referral to secondary care.

If the GP/Consultant wishes to treat, they must always apply for prior approval to the IFR service. Please fully complete the following:
Primary Hip or Knee Replacement Revision Surgery Form
and email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Laparoscopic fundoplication for chronic reflux oesophagitis
(funding for use in any other circumstance is Low Priority)
Procedure that requires Prior Approval
BPC 161
161 Gastric fundoplication for chronic reflux oesophagitis - Berkshire
Prior approval is always required from the IFR service before treatment

If the Consultant wishes to treat, they must apply for prior approval from the IFR service by fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria to the IFR service by email at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Laparoscopic gastro-oesophageal reflux surgery (LGORS) for patients with chronic gastro-oesophageal reflux disease
Procedure Funded Subject to Audit
BPC 93
93 Laparoscopic gastro oesophageal reflux surgery
This procedure is funded subject to audit. Please refer your patient directly by the e-Referral Service if they fully meet the criteria outlined in the policy.

If the Consultant wishes to treat and the patient does not fully meet the criteria then prior approval is always required from the IFR service prior to treatment. Please complete the following:
General Funding Form
or provide detailed clinical letters which clearly indicate how the policy criteria are met.
Please email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Laparoscopic surgery for colorectal cancerNHS EnglandFor further information contact NHS England
Lower Urinary Tract Symptoms in MenNHS EnglandFor further information contact NHS England
Lung resection for metastasesNHS EnglandFor further information contact NHS England
Male Circumcision and revision surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC63 Male Circumcision - November 2017
NEW
This procedure requires prior approval from the IFR service prior to referral and treatment in secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Male Circumcision Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Managing the boundaries of NHS and privately-funded healthcare
- NHS V Private Funding
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC35 Managing the boundaries of NHS and privately funded healthcare - July 2016

There is no obligation for the GP to prescribe treatment recommended by a private practitioner if it is contrary to local agreement or outside normal clinical practice.

The NHS will not normally fund treatments that have been recommended by a private practitioner if that treatment is not normally commissioned within the local area.

The fact that a patient can demonstrate they have benefited from the private treatment does not necessarily provide grounds for continuing the treatment in the NHS as an exception.

Patients who commence care privately can request that further treatment be provided within the NHS. Their clinical needs should be reassessed for NHS treatment within the same regime of priorities applicable to NHS patients with the same condition. Prior approval will be required from the IFR service if it is a restricted procedure. Please use the appropriate application form for the specific intervention required.

The CCG will not be responsible for retrospective funding of earlier treatment where patients who have received private treatment then transfer to the NHS.
Melatonin treatment in childrenThames Valley Priorities Committee Commissioning Policy Statement
TVPC54 Melatonin treatment in children - May 2017
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
Exceptional Circumstances Submission Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Methylphenidate and atomoxetine in attention deficit hyperactivity disorder (ADHD) in children and adolescentsMOBBB
14 Methylphenidate and atomoxetine in attention deficit hyperactivity disorder (ADHD) in Children and adolescents - July 2010
Methylphenidate, dexamfetamine and atomoxetine in attention deficit hyperactivity disorder (ADHD) in adultsPrescribing arrangement for the use of methylphenidate, dexamfetamine and atomoxetine in adult ADHD
Microwave ablation for lung metastasesNHS EnglandFor further information contact NHS England
Myringotomy and Grommets for otitis media with effusion (Grommets)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC20 Surgical Management of Otitis Media with effusion in children (under the age of 12 years)
This procedure always requires prior approval from the IFR service.

If after assessment, the Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
Grommets Application Form
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at https://www.england.nhs.uk/rightcare/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.
Neurosurgery for cerebral metastasesNational Policy
NHS England
Stereotactic radiosurgery - radiotherapy for cerebral metastases - April 2013
For further information contact NHS England
NHS England Specialised Commissioning Services
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC67 NHS England Specialised Commissioning Services - November 2017
Thames Valley CCGs do not fund specialised services, treatments or interventions that are directly commissioned by NHS England Specialised Commissioning whether they are provided by a specialised or non-specialised provider.
NHS Prescribing following private consultationThames Valley Priorities Committee Commissioning Policy Statement
TVPC36 NHS prescribing following private consultation - July 2016
NICE 'Do Not Do' recommendationsThames Valley Priorities Committee Commissioning Policy Statement
TVPC66 NICE identified interventions which should be discontinued or not used routinely due to lack of evidence of benefit - NICE 'Do Not Do' recommendations - November 2017
NEW
NICE 'Do Not Do' recommendations and the use of any intervention included in the NICE Savings and Productivity database as ‘Do Not Do’ is not normally funded. Exceptions to this may be stated in individual TVPC commissioning policy statements.
Non pharmacological services for dementia patients
Procedure Not Routinely Funded
MOBBB 63
63 Non pharmacological services for dementia patients
These services are not routinely funded and prior approval is always required from the IFR service.

If the GP wishes to refer, a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Open magnetic resonance imaging (MRI scans)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC53 Open magnetic resonance imaging (MRI) scans and standing / upright MRI scans - May 2017
This procedure always requires prior approval from the IFR service. If the GP / Clinician wishes to treat, approval from the IFR service must be obtained. Please fully complete the following:
MRI Scan Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration.

Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Orthodontics
NHS EnglandFor further information contact NHS England
Orthognathic surgeryNHS England
Interim Clinical Commissioning Policy: Orthognathic surgery - November 2013
For further information contact NHS England
Osteopathy and Chiropractic
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and funding approval must always be obtained from the IFR service prior to referral and treatment.

For these cases a strong case on grounds of exceptional health need must be provided. The GP must fully complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
Email the completed form to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Patella resurfacing as part of total knee replacement (TKR)
Procedure Not Routinely Funded
Berkshire East Clinical Commissioning Groups Policy Statement
Berkshire East CCGs policy patella resurfacing as part of total knee replacement (TKR) - October 2016
This procedure in not routinely funded and prior approval is always required from the IFR service prior referral and treatment in secondary care.
It is expected that these patients will have been referred, assessed and treated for their painful knee.

If a Consultant wishes to treat, they must apply by fully completing the following:
General Funding Form
and emailing it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Pectus anomaly surgery
- Pectus Excavatum, Pectus Carinatum
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC26 Pectus Anomaly Surgery
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need and the patient meets the criteria for consideration, please complete fully the following:
Aesthetic/Cosmetic General Surgery Form
or send detailed clinic letter(s) which clearly indicate how the patient meets the criteria for consideration and the exceptional health need. Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Penile Rehabilitation following prostate surgery
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC40 Penile Rehabilitation following prostate surgery - July 2016
This intervention is not routinely funded and prior approval is always required from the IFR service.

If the GP or a Consultant wishes to treat, a strong case on the grounds of exceptional health neeed must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Percutaneous pulmonary valve implantationNHS EnglandFor further information contact NHS England
Pharmacological treatments for the secondary prevention of osteoporotic fragility fractures in menMOBBB
82 Pharmacological treatments for the secondary prevention of osteoporotic fragility fractures in men - September 2012
Photodynamic Therapy (with Verteporfin)BPC
50 Photodynamic Therapy (with Verteporfin) - October 2002
Polysomnography in the investigation of children with sleep-related disordersNHS England

For further information contact NHS England
Pramipexole in the management of Restless Legs SyndromeBPC
115 Pramipexole in the management of Restless Legs Syndrome - November 2007
Preimplant genetic diagnosis (PGD)National Policy
NHS England
Pre-implantation Genetic Diagnosis(PGD) - April 2013

For further information contact NHS England
Primary Hip Joint Replacement
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC30 Primary hip joint replacement for patients with osteoarthritis of the hip - July 2016
This procedure requires prior approval from the IFR service before referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Primary Hip Replacement Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at:
https://www.england.nhs.uk/rightcare/useful-links/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.
Primary Knee Joint Replacement
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC7 Primary knee joint replacement surgery for patients with osteoarthritis of the knee - July 2016
This procedure requires prior approval from the IFR service before referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Primary Knee Replacement Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Patient Decision Aid is available at https://www.england.nhs.uk/rightcare/shared-decision-making/

Patient Decision Aid is available at:
https://www.england.nhs.uk/rightcare/useful-links/shared-decision-making/

Consultants must ensure that funding is in place prior to treatment.

Proton Pump Inhibitors in the treatment of dyspepsiaBPC 21
21 Proton Pump Inhibitors in the treatment of dyspepsia
If there is exceptional health need please complete the
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Radiofrequency Ablation and Cryotherapy for Renal TumoursNHS EnglandFor further information contact NHS England
Radiofrequency denervation for chronic low back pain
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This is a procedure which always requires prior approval from the IFR service.
If a GP wishes to refer to secondary care or a Consultant wishes to treat, please fully complete the following:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Email the completed form/letters to the IFR Service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Radiofrequency denervation for sacroiliac joint pain
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, and there is exceptional health need please fully complete the following form and demonstrate the exceptional health need:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration for consideration.

Consultants must ensure that funding is in place prior to treatment.
Real-time continuous glucose monitors for adults with type 1 diabetes
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC64 Real-time glucose monitors for adults with type 1 diabetes - April 2018
NEW
This device is funded subject to audit if the criteria outlined in the policy are fully met.
Research trials and NHS funding:
- Excess Treatment cost
- Post-trial treatments
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC38 Research trials and NHS funding - Excess treatment costs & Post-trial treatments - July 2016
These are not routinely funded and prior approval must always be obtained.
Reversal of Female Sterilisation
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC69 Reversal of female sterilisation and reversal of male sterilisation (vasectomy) - November 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service.

If the Gynaecology service, GP or the Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need, please either fully complete the following:
General Funding Form
or provide detailed clinic letter(s) that clearly outline the exceptional health need.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Reversal of Male Sterilisation
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC69 Reversal of female sterilisation and reversal of male sterilisation (vasectomy) - November 2017
NEW
This procedure is not routinely funded and prior approval is always required from the IFR service.

If the Gynaecology service, GP or the Consultant wishes to treat, a strong case on grounds of an exceptional health need must be provided. If there is exceptional health need, please either fully complete the following:
General Funding Form
or provide detailed clinic letter(s) that clearly outline the exceptional health need.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Robotic-assisted laparoscopic radical prostatectomyNHS EnglandFor further information contact NHS England
Sacral Nerve Stimulation in faecal incontinenceNational Policy
NHS England
Sacral nerve stimulation SNS for faecal incontinence in Adults - April 2013
For further information contact NHS England
Selective Dorsal RhizotomyNational Policy
NHS England
Selective dorsal rhizotomy
For further information contact NHS England
Sequential Cochlear implants in profoundly deaf childrenNHS EnglandFor further information contact NHS England
Serum P1PN measurement in the management of osteoporosisBPC
123 Serum P1NP measurement in the management of osterporosis - February 2008
Settings for alcohol detoxificationPublic HealthPublic Health
Severe and complex obesity
- Tier 1, Tier 2 and Tier 3
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC39 Severe and complex obesity-Eligibility for bariatric surgery-Interim Policy - July 2016
Weight Management
Services Tier 1, Tier 2 and Tier 3

Prior approval is required from the IFR service for referral to Tier 3 services. Please fully complete the following form
Weight Management Form
and email it with any supporting information to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Tiers 1-4
Tier 1 and 2 Primary Healthcare
Tier 3 accessed by referral from GP/ Primary Healthcare

In addition to offering a programme of care, Tier 3 services will select and refer patients for consideration for bariatric surgery. Some Tier 3 providers are listed below.
Tier 4 - Complex and Specialised Obesity Surgery

Tier 3 providers include:
Royal Berkshire NHS Foundation Trust
Patient Leaflet What to expect in a weight management clinic
Berkshire Health Care NHS Foundation Trust
Patient Leaflet Mindful Eating Berkshire East
Ashford & St Peter's Hospitals
Patient Leaflet Frequently asked questions Tier 3
Luton & Dunstable University Hospitals
Patient Leaflet The Weigh to go

Eligibility for Bariatric Surgery includes:
- Patients considered morbidly obese. Adults with a BMI of 40kg/m2 or more, or between 35kg/m2 and 40kg/m2 or greater in the presence of other significant diseases.
- Screening of co-morbidities and the detection of other significant diseases by MDT led processes prior to entering the surgical pathway.
- Morbid/severe obesity present for at least 5 years.
- Patient have recently received and complied with a local specialist obesity service weight loss programme (non-surgical Tiers 3/4). This will have been for the duration of 12-24 months. For patients with a BMI>50 attending a specialist bariatric service, this period may include the stabilisation and assessment period prior to bariatric surgery. The minimum acceptable period is 6 months.
- The specialist obesity weight loss programme and MDT (Tier 3/4)assesses evidence that all suitable non-invasive options have been explored and trialled

Tier 3 services will select and refer appropriate patients for consideration for bariatric surgery.
Severe and complex obesity
- Tier 4 Eligibility for bariatric surgery
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC39 Severe and complex obesity-Eligibility for bariatric surgery-Interim Policy - July 2016
Weight Management
Services including Bariatric Surgery

Please note information concerning Tier 1, Tier 2 and Tier 3 services as bariatric surgery is not offered outside of the MDT Tier 3 pathway. Application will be normally expected from the Tier 3 MDT/Consultants.
Tiers 1-4
Tier 1 and 2 Primary Healthcare
Tier 3 accessed by referral from GP/ Primary Healthcare

In addition to offering a programme of care, Tier 3 services will select and refer patients for consideration for bariatric surgery. Some Tier 3 providers are listed below.
Tier 4 - Complex and Specialised Obesity Surgery

Tier 3 providers include:
Royal Berkshire NHS Foundation Trust
Patient Leaflet What to expect in a weight management clinic
Berkshire Health Care NHS Foundation Trust
Patient Leaflet Mindful Eating Berkshire East
Ashford & St Peter's Hospitals
Patient Leaflet Frequently asked questions Tier 3
Luton & Dunstable University Hospitals
Patient Leaflet The Weigh to go

Eligibility for Bariatric Surgery includes:
- Patients considered morbidly obese. Adults with a BMI of 40kg/m2 or more, or between 35kg/m2 and 40kg/m2 or greater in the presence of other significant diseases.
- Screening of co-morbidities and the detection of other significant diseases by MDT led processes prior to entering the surgical pathway.
- Morbid/severe obesity present for at least 5 years.
- Patient have recently received and complied with a local specialist obesity service weight loss programme (non-surgical Tiers 3/4). This will have been for the duration of 12-24 months. For patients with a BMI>50 attending a specialist bariatric service, this period may include the stabilisation and assessment period prior to bariatric surgery. The minimum acceptable period is 6 months.
- The specialist obesity weight loss programme and MDT (Tier 3/4) assesses evidence that all suitable non-invasive options have been explored and trialled

Tier 3 services will select and refer appropriate patients for consideration for bariatric surgery.
Bariatric Surgery - Tier 4
Email the completed form with any supporting documents to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Short Burst Oxygen Therapy (SBOT) for the relief of episodic breathlessness
Procedure Funded and Subject to Audit
BPC 133
133 Short Burst Oxygen Therapy
This intervention is funded subject to audit where the criteria are met in full. Please refer your patient to the Specialist Respiratory Service.

If after assessment the criteria are not met in full but the Specialist Respiratory Service wishes to treat, they must apply for prior approval by fully completing the following:
General Funding Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria and the exceptional health needs. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Short sight/long sight corrective (laser) surgery (Refractive keratoplasty)
Procedure Not Routinely Funded
This procedure in not routinely funded.

Cases will only be considered where laser or operative correction is the only treatment available to restore reasonable visual acuity /or where there are substantial other medical reasons that make correction by external visual aids inappropriate.

This is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment. For these cases a strong case on grounds of exceptional health need must also be provided. Please fully complete the following:
General Funding Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Silicon Cosmesis for Prosthetic LimbsNHS EnglandFor further information contact NHS England
Snoring and Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) in adults
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC61 Snoring and Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) in adults - August 2017
Prior approval is always required from the IFR service prior to referral or treatment.

If the GP wishes to refer, or the Consultant wishes to treat, they must apply for prior approval by either fully completing the following:
Snoring and OSAHS Form - Adults
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria.

Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultant must ensure that funding is in place prior to treatment.

Link to STOP-Bang Questionnaire http://www.stopbang.ca/osa/screening.php
Sodium Oxybate for cataplexy and excessive daytime sleepiness in narcolepsyBPC
112 Sodium Oxybate for cataplexy and excessive daytime sleepiness in narcolepsy - June 2007
Spinal Cord Stimulation for ischaemic painNHS EnglandFor further information contact NHS England
Spinal Cord Stimulation in neuropathic painNHS EnglandFor further information contact NHS England
Spinal decompression for sciatica (including laminectomy, foraminotomy, undercutting facetectomy and discectomy)
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, and there is exceptional health need please fully complete the following form and demonstrate the exceptional health need:
Low Back Pain and Sciatica Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration for consideration.

Consultants must ensure that funding is in place prior to treatment.
Spinal fusion for people with low back pain
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

For these cases a strong case on grounds of exceptional health need must be provided. If the GP wishes to refer to secondary care, or a Consultant wishes to treat, please complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
or provide detailed clinic letters which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Spinal injections for managing low back pain including: facet joint injections, medial branch blocks, intradiscal injections, prolotherapy (proliferation therapy or regeneration injection therapy) and trigger point injections
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

For these cases a strong case on grounds of exceptional health need must be provided. If the GP wishes to refer to secondary care, or a Consultant wishes to treat, please complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
or provide detailed clinic letters which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Spinal manipulation for the treatment of chronic, non-specific low back pain
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC52 Management of low back pain and sciatica - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

For these cases a strong case on grounds of exceptional health need must be provided. If the GP wishes to refer to secondary care, or a Consultant wishes to treat, please complete the following form and clearly detail the exceptionality:
Low Back Pain and Sciatica Form
or provide detailed clinic letters which clearly indicate how the patient meets the criteria and the exceptional health need.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Spinal SurgeryNHS England
For further information contact NHS England
Standing and Upright Magnetic resonance imaging (MRI) scans
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC53 Open magnetic resonance imaging (MRI) scans and standing / upright MRI scans - May 2017
This procedure is not routinely funded and prior approval is always required from the IFR service. If there is exceptional health need please fully complete the following and indicating the exceptional health need:
MRI Scan Form
or provide detailed clinic letter(s) which clearly indicate how the patient meets the criteria and the exceptional health need.

Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Subacromial decompression for shoulder impingement
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC50 Subacromial decompression for shoulder impingement - Updated March 2018
NEW
This procedure always requires prior approval from the IFR service.

If after assessment, the Consultant wishes to treat, they must apply for prior approval by either fully completing the following
Subacromial Decompression of the Shoulder Form
or providing detailed clinic letter(s) which clearly indicate how the patient meets criteria.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Surgical resection and percutaneous ablation for colorectal liver metastasesNHS EnglandFor further information contact NHS England
Surgical techniques for the treatment of Oesophageal Stricture
Procedure Not Routinely Funded
BPC 63
63 Oesophageal stricture
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment.

If the Consultant wishes to treat, a strong case on grounds of exceptional health need must be provided. If there is exceptional health need please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly outline the exceptional health need by email to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Terbinafine (& other antifungal preparations) for Fungal Nail InfectionsBPC
74 Terbinafine (& other antifungal preparations) for Fungal Nail Infections - Octobeer 2004
Tonsillectomy
Procedure that requires Prior Approval

Thames Valley Priorities Committee Commissioning Policy Statement
TVPC22 Tonsillectomy for surgical management of recurrent tonsillitis and obstructive sleep apnoea in children and adults
This procedure always requires prior approval from the IFR service.

If the GP wishes to refer to secondary care, or if a Consultant wishes to treat, they must always apply for prior approval from the IFR service. Please fully complete the following:
Tonsillectomy Form
or send detailed clinic letter(s) which clearly indicate how the patient meets criteria. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Trans-cranial Doppler Ultrasonography with frequent transfusion to prevent stroke in children with sickle cellNHS EnglandFor further information contact NHS England
Transcatheter Aortic Valve implantation for aortic stenosisNational Policy
NHS England
Transcatheter Aortic Valve Implantation (TAVI) for Aortic Stenosis - April 2013
For further information contact NHS England
Trigger Finger
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC23 Trigger Finger
This procedure requires prior approval from the IFR service before referral to secondary care.

If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Trigger Finger Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets criteria. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Ultrasound guided injections for hip pain (trochanteric bursitis and osteoarthritis of the hip)
Procedure Funded and Subject to Audit
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC32 Ultrasound guided injections for hip pain (trochanteric bursitis and osteoarthritis of the hip) - July 2016
This procedure is funded subject to audit. Please refer your patient directly if they fully meet the criteria outlined in the policy.

If there is exceptional health need and the patient does not meet the criteria then prior approval must be obtained from the IFR service prior to referral or treatment. For these a strong case on the grounds of exceptional health need must be provided. Please fully complete the following:
General Funding Form
or provide detailed clinic letters which clearly indicate the exceptional health need and how the policy criteria are met.
Email the completed form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Use of continuous subcutaneous insulin infusion for diabetes - Insulin PumpsBPC
62 The use of Continuous Subcutaneous insulin infusion for diabetes - Insulin Pumps - December 2003
Vagus Nerve Stimulation (VNS) for refractory epilepsy in children and adultsNHS EnglandFor further information contact NHS England
Varicose Veins
Procedure that requires Prior Approval
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC1 policy recommendation Varicose Veins - Oct 2014
This procedure requires prior approval from the IFR service before referral and treatment.
If the GP wishes to refer to secondary care, or a Consultant wishes to treat, approval must be obtained from the IFR service by either fully completing the following:
Varicose Vein Form
or sending detailed clinic letter(s) which clearly indicate how the patient meets the criteria. Email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Vasectomy - Male Sterilisation
Referral into Secondary Care -
Procedure Not Routinely Funded
Thames Valley Priorities Committee Commissioning Policy Statement
TVPC4 Vasectomy - male sterilisation - November 2017
NEW
Please refer your patient for local anaesthetic vasectomy in primary care to Thames Valley Vasectomy Services. Please complete the following form and send it direclty to Thames Valley Vasectomy Services tvvs.admin@nhs.net for consideration.

Vasectomy referral form - Word Format
Vasectomy referral form - EWDT

If the GP wishes to refer into secondary care or the patient does not fully meet the criteria but there is an exceptional health need prior approval is always required from the IFR service prior to treatment. For these requests a strong case on the grounds of exceptional health need must be provided. Please fully complete the following:
General Funding Form
or send detailed clinic letter(s) which clearly indicate how the policy criteria are met and why the patient cannot be treated in primary care.
Please email the form/letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.
Vertebroplasty and Kyphoplasty NICE TA 279
If the patient does not meet in full the NICE TA prior approval is always required from the IFR service before referral and treatment. Please fully complete the following:
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Vertebroplasty and Kyphoplasty NICE TA 279
If the patient does not meet in full the NICE TA prior approval is always required from the IFR service before referral and treatment. Please fully complete the following:
Exceptional Circumstances Submission Form
and email it to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.
Verteporfin and photodynamic therapy in Chronic Central Serous Chorioretinopathy and Idiopathic Polypoidal Choroidal VasculopathyThames Valley Priorities Committee Commissioning Policy Statement
TVPC42 Verteporfin and photodynamic therapy in Chronic Central Serous Chorioretinopathy and Idiopathic Polypoidal Choroidal Vasculopathy - August 2016
Prior approval is not required where the patient meets the criteria in full.

If the criteria are not fully met, prior to referral and treatment, please complete the following:
General Funding Form
or provide detailed clinic letters which clearly indicate how the policy criteria are met.
Please email the completed form /letters to the IFR service at BerksEast.IFRrequests@nhs.net for consideration.

Consultants must ensure that funding is in place prior to treatment.

 

For more information
Please email the IFR service at Berkseast.ifrrequests@nhs.net for all enquiries about the policy statements or the process for considering Individual Funding Requests.