Policies – Bedfordshire

Cosmetic, Other Surgeries, Devices, Screening and 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 Beds.IFRrequests@nhs.net for consideration.If you are having difficulties finding the information you require please call 01494 555530 where a member of the IFR service will assist you.

INTERVENTION

POLICY STATEMENT
(Current policy, referral guidelines or under the remit of NHS England)
PROCESS PATHWAY
(Pathway for treatment and appropriate forms)
Adenoidectomy
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
40 Adenoidectomy - Feb 2016
Please note that the patient must also meet the criteria for policy 18 Grommet insertion for Glue Ear (otitis media with effusion) and recurrent acute otitis media in children
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Grommets with Adenoidectomy Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Aesthetic/Cosmetic Breast Surgery (Breast implant removal and replacement)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
02 - Cosmetic breast surgery - August 2017
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Breast Implant Removal and Replacement Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Cosmetic breast surgery will not normally be considered for those under 18.
Aesthetic/Cosmetic Breast Surgery (Female breast reduction, reduction mammoplasty)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
02 - Cosmetic breast surgery - August 2017
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Female Breast Reduction Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Cosmetic breast surgery will not normally be considered for those under 18.
Aesthetic/Cosmetic Breast Surgery (including breast augmentation, revision of breast augmentation, asymmetry, mammoplasty, mastopexy - breast lift, inverted nipple, supernumerary nipple, excluding cancer/breast reconstruction relating to cancer)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
02 - Cosmetic breast surgery - August 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Breast Surgery Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Cosmetic breast surgery will not normally be considered for those under 18.
Aesthetic/Cosmetic Breast Surgery (Male breast reduction for gynaecomastia)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
02 - Cosmetic breast surgery - August 2017
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Male Breast Reduction Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Cosmetic breast surgery will not normally be considered for those under 20.
Aesthetic/Cosmetic Treatment and Surgery
Including abnormally placed hair/ hirsutism (including elfornithine), correction of alopecia (hair loss including Intralace), correction of male pattern baldness, hair transplantation, hair grafting, intralace, pinnaplasty for adults and children (bat ears), reconstruction /revision of external ear, split earlobes, meatoplasty/plastic operations on external ear (lobe repair), scar removal/revision including keloid and hypertrophic, excision of skin tags (not including fistula's), tattoo removal/revision, botox for cosmetic reasons, excision of sweat bearing glands, endoscopic thoracic sympathectomy for facial blushing and/ or sweating, penile prosthesis /enlargement, genital surgery (male or female), appliances and devices for cosmetic purposes (high-grade silicon cosmesis and/or prosthesis)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
01 - Provision of cosmetic treatments and surgery - August 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Aesthetic/Cosmetic Surgery Form
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Aesthetic/Cosmetic Treatment and Surgery - Eye Surgery
Including but not limited to Blepharoplasty, Browlift (rhytidectomy), Chalazion/Meibomian cysts, correction of Ptosis, surgery for Ectropion or Entropion of the eyelid
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
88 - Blepharoplasty - February 2018
NEW

Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
01 - Provision of cosmetic treatments and surgery - August 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Aesthetic Surgery Form - Eye Surgery
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Arthroscopic lavage and debridement (knee washout, with or without debridement) for the management of osteoarthritis
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
21 Arthroscopy and arthroscopic knee washouts - Sept 2014
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Arthroscopy for non-osteoarthritic conditions of the knee
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
21 Arthroscopy and arthroscopic knee washouts - Sept 2014
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.

Assisted conception
Procedure that requires Prior Approval for couples who do not meet the criteria in full
Bedfordshire Clinical Commissioning Group Commissioning Policy
Fertility Services Commissioning Policy August 2017
Consultant to apply for funding.
Cases where couples do not meet the criteria in full require prior approval for this intervention from the IFR service before referral and treatment.

Please fully complete the following:
IVF Consultant Referral Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

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.
Asthma device
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum statement
62 Temperature - controlled laminar airflow device for the treatment of chronic allergic asthma- March 2014
GP to apply for funding.
This device is not routinely funded and prior approval is always required from the IFR service. Please fully complete the following:
General Funding Form
and complete the
62 Mini AQLQ and Quality of life form.
Email the completed forms to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Autologous Blood and Platelet-Rich Plasma Injection in Tendinopathy
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
75 - Autologous Blood and Platelet-Rich Plasma Injection in Tendinopathy - June 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Bone Anchored Hearing AidsNational Policy
NHS England
Bone anchored hearing aids - April 2013
For further information contact NHS England
Breast reconstruction after treatment for breast cancer
Further surgery required beyond the original documented treatment plan for primary reconstruction, in excess of three intial procedures; or beyond 2 years after the first procedure
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
73 - Breast reconstruction after treatment for breast cancer - August 2017
GP/Consultant to apply for funding.

Cosmetic/reconstructive surgery to reduce discomfort and improve appearance following initial cancer surgery will be funded if it involves a maximum of 3 procedures within 2 years of initial reconstructive surgery in order to adequately complete reconstruction.

Any further surgery required beyond the original documented treatment plan for primary reconstruction; in excess of 3 initial procedures or beyond 2 years after the first procedure will always require prior approval from the IFR service before referral and treatment in secondary care.

This procedure in not routinely funded and patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Breast Reconstruction after treatment for breast cancer Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Carpal Tunnel Syndrome - Surgical treatment
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
36 Carpal tunnel syndrome, Dupuytren's contracture and Trigger Finger - March 2014
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Cataract removal in adults (including second eye cataract surgery)
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Priorities Forum Statement
31 Clinical threshold for elective cataract surgery - March 2017
GP/Consultant to apply for funding if outside of criteria.
Prior approval is not required where the patient meets the criteria in full.
This intervention will be audited as per the contract audit process.

If the patient does not meet criteria and there is a strong case on grounds of an exceptional health need, please fully complete the following:
Cataract Referral Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Caudal epidural injections in the management of spinal pain
Procedure Not Routinely Funded
contact the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
55 Back Injections the elective use of epidural and facet joint injections and denervation of facet joints in management of back pain - April 2017
GGP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Chelation therapy in the treatment of cardiovasular disease, autism and chronic fatigue syndrome (CFS)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
56 Chelation therapy in the treatment of cardiovascular disease, autism and chronic fatigue syndrome - Feb 2016
Consultant to apply for funding.
This intervention is not normally funded for cardiovascular disease, autism and chronic fatigue syndrome as there is a lack of evidence for the efficacy of chelation therapy.

Consideration will only be given for heavy metal poisoning or overload.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Cholecystectomy (Gallbladder, gallstones, cholecystitis, biliary colic)
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Priorities Forum Statement
60 Cholecystectomy - Feb 2016
Consultant to apply for funding if outside of policy.
Prior approval is not required where the patient meets the criteria in full.
This intervention will be audited as per the contract audit process.

If the patient does not meet criteria and there is a strong case on grounds of an exceptional health need, please fully complete the following before referral and treatment:
Cholecystectomy Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Chronic Fatigue Syndrome/ Myalgic Encephalitis (CFS/ME)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
49 Chronic Fatigue Syndrome / Myalgic Encephalitis - Sept 2008
GP/Consultant to apply for funding.
Patients to follow the local guidelines for treatment for CFS/ME.

For all cases which require out of area or inpatient care, these treatments are not normally funded, and will require funding to be in place prior to referral and treatment.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.


Circumcision
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
08 Circumcision - May 2015
GP to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment.

Please fully complete the following the following:
Male Circumcision Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Complementary and Alternative Therapies
including: Acupuncture, Aromatherapy, Ayurvedic Medicine, Body Massage, Chinese Medicine, Crystal Therapy, Dowsing, Functional Therapy Sessions, Herbal Medicine, Homeopathy, Hypnotherapy, Movement Therapy, Reflexology, Alexander techniques, Osteopathy, Chiropractic, Relaxation Therapy Sessions
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
48 Complementary and Alternative Medicine (CAM) - Sept 2013
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have tried all other treatment options and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Continuous Glucose Monitor (Children and Adults)
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
66 Continuous Glucose Monitor - June 2014
Consultant to apply for funding.
All cases require prior approval for this device from the IFR service before referral and treatment. Please fully complete the following:
Continuous Glucose Monitor Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Deep Brain Stimulation for Parkinson’s Disease
National Policy
NHS England
Deep Brain Stimulation DBS in movement disorders
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
For further information contact NHS England
Deep Brain Stimulation including other interventions
National Policy
NHS England
Deep Brain Stimulation for Indications except movement disorders
For further information contact NHS England
Defining Boundaries between NHS vs Private
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
BCCG Defining the Boundaries NHS vs Private
GP to apply for funding.
All cases require prior approval to transfer from Private treatment into NHS treatment from the IFR service before referral and treatment. Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Dental ImplantsNHS England
NHS Dental Services
For further information contact NHS England
Dilation and curettage (D&C) - Therapeutic
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
Full document with all sections -
Guidance 26 - Heavy Menstrual Bleeding - August 2017

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 Safery Alert - 9 February 2018


Document split for ease of use:
Policy - Guidance 26 - Heavy Menstrual Bleeding - August 2017
Guidance 26 - Definitions
Annexes A and B -
26 - Heavy Menstrual Bleeding Annexes - August 2017
Patient Decision Aid -
26 - Heavy Menstrual Bleeding Shared Decision Making - August 2017
Patients should be referred to the intermediate Gynaecology Service for assessment and counselling.
D&C is not therapeutic in cases of heavy menstrual bleeding. A D&C does not give additional diagnostic information over and above a hysteroscopy with endometrial biopsy. This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment, Consultant is to apply for funding.
Divarication of the Recti
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
63 Divarication of the Recti - June 2014
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care. These patients must have completed all other treatment options and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Divarication of the Recit Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Division of Ankyloglossia ( Tongue Tie in Children) - Infants with feeding problems
Infants outside of criteria or if day-case or inpatient surgery
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
57 Division of Ankyloglossia (Tongue Tie) for breast feeding infants and older children/ adults - June 2014
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Tongue Tie Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Division of Ankyloglossia ( Tongue Tie) - For older children or adults with speech problems
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
57 Division of Ankyloglossia (Tongue Tie) for breast feeding infants and older children/ adults - June 2014
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Tongue Tie Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Division of Ankyloglossia (Tongue Tie in Children) - Infants with feeding problems
For those meeting the criteria and require outpatient procedures only
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Priorities Forum Statement
57 Division of Ankyloglossia (Tongue Tie) for breast feeding infants and older children/ adults - June 2014
Prior approval is not required where patient meets the criteria in full.

This intervention will be audited as per the contract audit process, Consultant to apply for funding if outside of criteria.
Dupuytren's Contracture - (Palmar fasciectomy)
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
36 Carpal tunnel syndrome, Dupuytren's contracture and Trigger Finger - March 2014
GGP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Dupuytren's Contracture - (Radiotherapy)
Procedure Not Routinely Funded
contact Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
36 Carpal tunnel syndrome, Dupuytren's contracture and Trigger Finger - March 2014

GGP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Facet Joints injections (therapeutic and diagnostic) which include intra-articular injections and medial branch blocks
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)

Pain Management service referrals
Procedure that requires Prior Approval
from the IFR service

Bedfordshire and Hertfordshire Priorities Forum Statement
55 Back Injections the elective use of epidural and facet joint injections and denervation of facet joints in management of back pain - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.

If the Pain Management service Consultant wishes to treat, they must always apply for prior approval to the IFR service. Please fully complete the following:
Facet Joint Injection & Medial Branch Blocks Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Faecal Microbiota Transplants
Procedure Funded Subject to Audit
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
83 - Faecal Microbiota Transplants - February 2018
NEW
Consultant to apply for funding if outside of criteria.
Prior approval is required where the patient meets the criteria in full.
This intervention will be audited as per the contract audit process.

If the patient does not meet the criteria and there is a strong case on grounds of exceptional health need, please fully complete the following:
General Funding Form
Email the completed forms to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Flash Monitoring System (FreeStyle Libre®)Bedfordshire and Luton Joint Prescribing Committee (JPC) - June 2018 / updated October 2018
Bulletin 266: FreeStyle Libre® (Flash Glucose Scanning {FGS}: guidance for the use of FGS in adults (age 19 and older) with type 1 diabetes
NEW

Bedfordshire and Luton Joint Prescribing Committee (JPC) - June 2018 / updated October 2018
Bulletin 265: FreeStyle Libre® (Flash Glucose Scanning {FGS}: guidance for the use of FGS in children and young people with type 1 diabetes age 4 up to {ie less than} age 19
NEW
Bedfordshire CCG currently fund FreeStyle Libre®. The current commissioning position came into effect as of 1st August 2018 - funding criteria is in line with the JPC recommendations for up to a specified maximum number of patients per annum agreed with each Trust via a CCG approval (Blueteq) process.
Supply of the device/sensors will be undertaken by the Specialised Diabetes Teams at Bedford Hospital NHS Trust and the Luton & Dunstable University Hospital NHS Trust with no GP prescribing, no additional activity charges and subject to audit.
For patients under the care of other Trusts, GPs are asked to contact the Bedfordshire CCG Medicines Optimisation Team for advice.

Specialist teams are requested in the first instance to apply via the online Blueteq High Cost Drugs system (see proformas below if Blueteq is unavailable) if the patient meets the criteria listed in bulletins 265 and 266. If the patient does not fit the locally agreed criteria and clinical exceptionality is demonstrated, clinicians may apply through the IFR devices route for funding consideration. IFR requests should be sent to Beds.IFRrequests@nhs.net.

Bedfordshire CCG Patient Contracts for FreeStyle Libre (flash glucose monitoring):
- FreeStyle Libre® Flash glucose Scanning {FCG} Patient Agreement (for Adults)
- FreeStyle Libre® Flash glucose Scanning {FCG} Patient Agreement (for Children and young people aged upto age 19 years)

Bedfordshire CCG Proformas for FreeStyle Libre (flash glucose monitoring):
- FreeStyle Libre® Flash Glucose Scanning System (FGS) for adults
- FreeStyle Libre Flash Glucose Scanning System (FGS) - for children and young people (age 4 upto age 19 years
Functional Electrical Stimulation (FES) for Drop Foot of central neurological origin
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
59 Use of Functional electrical stimulation - Aug 2015
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have completed the full NHS pathway for treatment and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Functional Electrical Stimulation New Request Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

The use of FES cycle is not routinely funded.
Functional Electrical Stimulation (FES) for neurological conditions (including upper limb, shoulder, elbow, wrist and hand)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
59 Use of Functional electrical stimulation - Aug 2015
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have completed the full NHS pathway for treatment and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Functional Electrical Stimulation New Request Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

The use of FES cycle is not routinely funded.
Functional Electrical Stimulation - Maintenance and support for patients already being treated with FES
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
59 Use of Functional electrical stimulation - Aug 2015
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service on an ongoing basis once the initial funding has been agreed. Please fully complete the following:
FES ongoing Maintenance and Support of equipment Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

The use of FES cycle is not routinely funded.
Ganglion excision and re-excision - (Wrist, hand, knee, foot, other ganglion)
Procedure Not Routinely Funded
contact Bedfordshire MSK service (Circle Bedfordshire
Bedfordshire and Hertfordshire Priorities Forum Statement
16 Treatment for a ganglion - April 2012
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Gastric Electrical Stimulation in Gastroparesis
Procedure Not Routinely Funded
Referral and Treatment Guidelines
69 Gastric Electrical Stimulation in Gastroparesis-Aug 2015
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to treatment. These patients must have completed the full NHS pathway for treatment and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Gastric Electrical Stimulation in Gastroparesis Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Gender dysphoria or post gender reassignment surgery - Cosmetic Interventions (including augmentation mammoplasty, hair removal, chondroplasty, crico-thyroid approximation surgery, rhinoplasty, jaw reduction, waist liposuction)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
53 Cosmetic interventions for individuals with gender dysphoria or post gender reassignment surgery - Feb 2016
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment. These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Aesthetic/Cosmetic Surgery Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Gender Reassignment surgery for the treatment of Gender DysphoriaNational Policy
NHS England
Interim Gender Dysphoria Protocol and Service Guidelines 2013/14
Patients should be referred to a specialist centre in line with the NHS England National Policy.
Grommet insertion/ Myringotomy - Adults
Procedure Funded Subject to Audit
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
72 - Grommet Insertion in Adults - August 2017
GP/Consultant to apply for funding if outside of criteria.
Prior approval is not required where the patient meets the criteria in full. This intervention will be audited as per the contract audit process.

If the patient does not meet the criteria and there is a strong case on grounds of exceptional health need please fully complete the following clearly detailing the exceptionality:
Grommets for Adults
Email the form and supporting information to the IFR service at Beds.IFRrequests@nhs.net for consideration.

This intervention will be audited as per the contract audit process.
Grommet insertion/ Myringotomy - Children
Procedure Funded Subject to Audit
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
18 - Grommet Insertion for Glue Ear and Recurrent Acute Otitis Media in children - August 2017
GP/Consultant to apply for funding if outside of criteria.
Prior approval is not required where the patient meets the criteria in full. This intervention will be audited as per the contract audit process.

If the patient does not meet the criteria and there is a strong case on grounds of exceptional health need, please fully complete the following:
Grommets Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

This intervention will be audited as per the contract audit process.
Hallux Valgus (Bunions)
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)

Bedfordshire and Hertfordshire Priorities Forum Statement
41 Hallux Valgus (bunions) - Feb 2016
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Hernia - Femoral, Spigelian or Inguino-scrotal
Prior Approval not required
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
25 - Management of abdominal hernias in adults - August 2017
NEW
Where there is clear evidence that there is a femoral, spigelian or inguino-scrotal hernia with an identifiable health need these should be referred to secondary care.

This intervention does not require prior approval, GP to apply for funding if outside of policy.

Hernia - (abdominal/ventral)
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
25 - Management of abdominal hernias in adults - August 2017
NEW
GP to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Hernia Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Hernia - Inguinal
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
25 - Management of abdominal hernias in adults - August 2017
NEW
GP to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Hernia Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Link to Patient Decision Inguinal hernia decision aid
Hernia - Umbilical, Para-umbilical, Epigastric and Incisional hernia
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
25 - Management of abdominal hernias in adults - August 2017
NEW
GP to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Hernia Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Please note for Epigastric Hernia please review policy 63 Divarication of the Recti Muscle
High Cost Drugs Excluded from National Tariff – NICE compliant or local JPC policy compliantNICE Technology Appraisal or local JPC policy.Electronic completion of the high cost drug forms via Blueteq® is the preferred method of submitting a High Cost Drug Funding Requests. For Trusts who are not currently operating Blueteq®, please complete the relevant Proforma and email it to the IFR service at Beds.IFRrequests@nhs.net
High cost drug proformas are available at:
Commissioning – HCD – Proformas
For high cost drugs which are “notification only” if the patient fulfils the proforma / NICE criteria then provider Trusts can commence treatment without the need to wait for acknowledgement / approval. For “prior approval” high cost drugs, approval is required prior to treatment.
High Cost Drugs Excluded from National Tariff – non-NICE compliant / outside of local JPC policy criteria or no CCG policyBedfordshire CCG Individual Funding Request Policy - February 2016These interventions are not routinely funded and prior approval is always required prior to treatment.
Please complete the following form:
Individual Funding Request Form - Drugs Only
and email it to the IFR service at Beds.IFRrequests@nhs.net
Hip Arthroscopy - (Excision/repair of radiological proven labral tears in the absence of OA or FAI)
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
70 Hip Arthroscopy - Aug 2015
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Hip Arthroscopy - (Femoro-Acetabular Impingement (FAI)
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
70 Hip Arthroscopy - Aug 2015
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.

Hip Arthroscopy - (Sepsis of hip joint)
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
70 Hip Arthroscopy - Aug 2015
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Hip Arthroscopy - Proven loose bodies
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
70 Hip Arthroscopy - Aug 2015
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.

Arthroscopy as a diagnostic tool where there is a suspicion of loose bodies is not normally funded and requires prior approval.
Hip Arthroscopy - Suspicion of loose bodies for diagnostic use
Procedure Not Routinely Funded
contact Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
70 Hip Arthroscopy - Aug 2015
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Hyperbaric Oxygen Treatment(HBOT) National Policy
NHS England
The Use of Hyperbaric Oxygen Therapy

For further information contact NHS England
Hyperhidrosis (Amputation stumps)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
51 - The Management of Hyperhidrosis - October 2017
NEW
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Hyperhidrosis (Endoscopic Thoracic Sympathectomy-ETS)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
51 - The Management of Hyperhidrosis - October 2017
NEW
Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Hyperhidrosis (Iontophoresis machine)
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
51 - The Management of Hyperhidrosis - October 2017
NEW
This device is not normally funded as patients are expected to purchase their own machine for home treatment. These will not be funded on the NHS.
Hyperhidrosis (laser sweat ablation or retrodermal curettage)
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
51 - The Management of Hyperhidrosis - October 2017
NEW
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment.
Please fully complete the following:
General Funding Form
Hysterectomy
Procedure Funded Subject to Audit
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
Full document with all sections -
Guidance 26 - Heavy Menstrual Bleeding - August 2017

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 Safery Alert - 9 February 2018

Document split for ease of use:
Policy - Guidance 26 - Heavy Menstrual Bleeding - August 2017
Guidance - Definitions
Annexes A and B -
26 - Heavy Menstrual Bleeding Annexes - August 2017
Patient Decision Aid -
26 - Heavy Menstrual Bleeding Shared Decision Making - August 2017
Prior approval is not required where the patient meets the criteria in full.
This intervention will be audited as per the contract process

If the patient does not meet criteria and there is a strong case on grounds of an exceptional health need, please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Infrared A Induced Whole Body Hyperthermia - (Arterial hypertension, muscle tension, chronic back pain, fibromyalgia syndrome, neuralgia, migraine, chronic inflammatory disorders, chronic rhinitis, bronchial asthma, Seasonal Affective Disorder, rehabilitation in sports medicine, detoxification in those exposed to pollutants, chronic viral illness)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
12 Infrared A Induced Whole Body Hyperthermia - Feb 2016
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before treatment.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Inpatient and Outpatient Pain Management Programmes
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
13 Inpatient and Outpatient Pain Management Programmes - Dec 2011
GP to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment. Please fully complete the following:
Inpatient & Outpatient Pain Management Programmes Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Interlaminar epidural injections and transforaminal epidural injections for patients with radicular pain due to herniated disc (sciatica)
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)

Bedfordshire and Hertfordshire Priorities Forum Statement
55 Back Injections the elective use of epidural and facet joint injections and denervation of facet joints in management of back pain - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Labiaplasty, Vaginoplasty, Clitoroplasty or Hymenopathy - All requests (Excluding cancer, significant congenital malformation, endocrine abnormalities such as adrenal hyperplasia or Turners syndrome)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
65 Labiaplasty and Vaginoplasty - May 2015
Consultant to apply for funding.
These procedures are not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Labiaplasty or Vaginoplasty Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

This treatment is only commissioned for cancer, significant congenital malformation, endocrine abnormalities of adrenal hyperplasia or Turners syndrome).
Laser Eye Surgery in Myopia
- including LASIK, LASEK, PRK
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
80 - Laser Eye Surgery in Myopia - October 2017
NEW
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have a strong case on grounds of exceptional health need. If there is a strong case please fully complete the following form:
General Funding Form
Email the completed forms to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Low Intensity Pulsed Ultrasound Therapy for Bone Healing (Exogen®) - Non-union/healing fractures
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
54 Low Intensity Pulsed Ultrasound Therapy for Bone Healing (Exogen) - November 2016
All cases require prior approval for this intervention from the IFR service before treatment.
If the patient fully meets the criteria complete the following:
Exogen Form and email the form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Lycra Dynamic Splinting for Children with Neurological Impairment
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
17 Lycra dynamic splinting for children with neurological impairment - Dec 2011
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before treatment.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Lymphoedema (inpatient or complex treatment)
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Interim Priorities Forum Statement
05 Lymphoedema - Sept 2014
GP/Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

All patients are to follow the standard NHS pathway for treatment in the first instance as outlined within policy 5.
Management of Female Incontinence - Referral guidelines for Primary and Secondary Care
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Guidance Statement
61 Management of female incontinence - May 2016
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment.

Please fully complete the following:
Surgery for Stress Incontinence Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Prior to consideration for surgery and onward referral to secondary care the patient must have completed the NHS pathway within primary care.
Management of Female Pelvic Organ Prolapse (Uterine) - Referral guidelines for Primary and Secondary Care
Procedure that requires Prior Approval
Bedfordshire Interim Guidance Statement
Surgery for Uterine Prolapse


Patients are to be referred to the local Intermediate Gynaecology Service for assessment and treatment.

If the Gynaecological Service wishes to refer to secondary care, or if a Consultant wishes to treat, they must have prior approval from the IFR service before treatment, then the Consultant is to apply for funding.

Please fully complete the following:
Surgery for Uterine Prolapse Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Prior to consideration for surgery and onward referral to secondary care the patient must have completed the NHS pathway within primary care.
Management of Haemorrhoids
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
58 Management of Haemorrhoids - May 2015
Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before treatment.

Please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Management of Heavy menstrual bleeding - (Menorrhagia) including referral criteria, Hysterectomy, Endometrial Ablation, Uterine Artery Embolization and use of Ulipristal Acetate, IUD, Prophylactic antibiotics, (fibroids, polyps),
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
Full document with all sections -
Guidance 26 - Heavy Menstrual Bleeding - August 2017

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 Safery Alert - 9 February 2018

Document split for ease of use:
Policy - Guidance 26 - Heavy Menstrual Bleeding - August 2017
Guidance 26 - Definitions
Annexes A and B -
26 - Heavy Menstrual Bleeding Annexes - August 2017
Patient Decision Aid -
26 - Heavy Menstrual Bleeding Shared Decision Making - August 2017
Consultant to apply for funding.
Patients are to be referred to the local Intermediate Gynaecology Service for assessment and treatment.

If the Gynaecological Service wishes to refer to secondary care, or if a Consultant wishes to treat, they must have prior approval from the IFR service before treatment.

All cases require prior approval from the IFR service before treatment in secondary care. Please fully complete the following:
Management of Heavy Menstrual Bleeding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Prior to consideration for surgery and onward referral to secondary care the patient must have completed the NHS pathway within primary care.
Management of Hyperhidrosis with Botulinum Toxin A (Axillary Hyperhidrosis, Palmar Hyperhidrosis, Craniofacial Hyperhidrosis)
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
51 - The Management of Hyperhidrosis - October 2017
NEW
Consultant should apply for funding via the Bedfordshire High Cost Portal.

Funding will be on a case by case basis only.

If the patient does not meet the criteria and the GP or Consultant wishes to treat and there is exceptional health need, please fully complete the following form:
Botulinum Toxin A - Management of Hyperhidrosis Form
and attach clinical details which demonstrate the exceptional health need.
Email the form and information to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Management of Overweight and Obese Adults Referral CriteriaBedfordshire and Hertfordshire Priorities Forum Statement
39 Management of overweight and obese adults - June 2014
Patients must meet the full criteria as per Policy 39 Management of Overweight and Obese Adults for referral to Tier 3.
Please complete the following:
Weight Management Form - Tier 3
Email the completed form with any supporting information to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Prior approval prior to surgery is required for Tier 4/
Please complete the following:
Bariatric Form - Tier 4
Email the completed form with any supporting information to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Management of Premature Ejaculation referral criteria


Bedfordshire and Hertfordshire Interim Priorities Forum Statement
67 Management of Premature Ejaculation - May 2015
Patients are to referred in line with the referral criteria policy 67.
Consultant to apply for funding if outside of criteria.
Management of Snoring referral criteriaBedfordshire and Hertfordshire Interim Priorities Forum Statement
35 Management of snoring - Nov 2011
Patients are to be managed within Primary Care as outlined in policy 35 unless there is an Epworth Sleepiness score (ESS≥11) where a diagnosis of sleep apnoea is apparent.
Where funding is needed, the GP is to apply for funding.
Where sleep apnoea is apparent please fully complete the following:
Management of Snorning Form
along with a completed Epworth Sleepiness score sheet.
Email the completed forms to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Mandibular or maxillary osteotomyBedfordshire and Hertfordshire Priorities Forum Statement
11 Mandibular or maxillary osteotomy - Feb 2016
Patients should be referred to a specialist service. For further information contact NHS England
Minor Skin Procedures for Benign Lesions and Lipomata
including removal of: acne vulgaris, dermatofibromas (skin growths), lipoma and lipomata (fat deposits under the skin), naevi (benign pigmented naevi, epidermal, haemangioma, moles, spider, congenital and port-wine), onychomycosis (fungal nail infections), rosacea, sebaceous cysts (pilar and epidermoid cysts) seborrhoeic keratosis (benign skin growths, basal cell papilloma, senile warts), skin tags (not including fistula's), telangiectasia (HHT, spider and threat veins), vitiligo, warts (plantar including verrucae, filiform and common), xanthelasmas (cholesterol deposits underneath the skin), laser removal of skin lesions, congenital vascular abnormalities
Excludes lesions where there is a suspicion of malignancy e.g.BCC and SCC
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
01 - Provision of cosmetic treatments and surgery - August 2017
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care. These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need the consultant is to apply for funding - please fully complete the following:
Benign Skin Lesions and Lipomata Form
and email it to the IFR service atBeds.IFRrequests@nhs.net for consideration.

If GP’s are referring outside of this pathway prior approval must always be obtained before referral and treatment using the above form.
MRI (Upright and Open)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
64 Open MRI Scanning - June 2014
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral.

These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
MRI Scan Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Music therapy in children
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
04 Music Therapy in children - May 2015
GP to apply for funding.
All cases require prior approval from the IFR service before referral and treatment in secondary care. Please fully complete the following:
Music Therapy Form - Child
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Non-specific low back pain - Discectomy and fusion
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)


Bedfordshire and Hertfordshire Priorities Forum Interim Statement
44 Management of Low Back Pain - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Non-specific low back pain - Trigger point and sclerosant injections
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)

Bedfordshire and Hertfordshire Priorities Forum Interim Statement
44 Management of Low Back Pain - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.

Occipital Nerve Stimulation for adults with intractable chronic migraines and medically refractory chronic cluster headaches - Out for public consultation - NHS EnglandNHS England Draft Consulation Document
This intervention is not normally funded by the NHS. ONS for the treatment of headaches should only be offered as part of an externally funded, ethically approved, clinical trial.

This intervention will not be considered through the local IFR process.
Occipital Nerve Stimulation for the treatment of headaches
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
14 Occipital Nerve Stimulation for the treatment of headaches - Dec 2011
This intervention is not normally funded by the NHS. ONS for the treatment of headaches should only be offered as part of an externally funded, ethically approved, clinical trial.

This intervention will not be considered through the local IFR process.
Onychomycosis (Fungal nail infection)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
19 Onychomycosis - fungal nail infection - Feb 2012
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment. These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Onychomycosis (fungal nail infection) Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Patella Resurfacing
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
76 - Patella Resurfacing - June 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Pectus anomaly surgery
- including pectus excavatum, pectus carinatum, pectus arcuatum
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
84 - Pectus anomaly surgery - February 2018
NEW

Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
01 - Provision of cosmetic treatments and surgery - August 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required form the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of exceptional health need. If there is a strong case of exceptional need please fully complete the following form:
Aesthetic/Cosmetic Surgery Form
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Penile Prosthesis for Erectile Dysfunction
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
15 Penile Prostheses for Erectile Dysfunction - Dec 2011
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Penile Rehabilitation following prostate surgery
- Phosphodiesterase-5(PDE5) inhibitors or Alprostadil
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
85 - Penile rehabilitation following prostate surgery - February 2018
NEW
GP/Consultant to apply for funding.

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 be provided. Please fully complete the following:
Individual Funding Request Form - Drugs Only
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Penile Rehabilitation following prostate surgery
- Vacuum erection devices
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
85 - Penile rehabilitation following prostate surgery - February 2018
NEW
GP/Consultant to apply for funding.

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 be provided. Please fully complete the following:
General Funding Form
Email the completed forms to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Plagiocephaly - Craniosynostosis
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Priorities Forum Statement
38 Plagiocephaly - March 2010
If there is diagnostic doubt referral should be made to a local paediatric consultant. If there is then a strong clinical suspicion of cranio-synostosis, onward referral to a regional craniofacial centre is appropriate.

This intervention will be audited as per the contract audit process.
Consultant to apply for funding if outside of policy.
Plagiocephaly - Nonsynostotic or positional plagiocephaly (deformational plagiocephaly, flat-head syndrome, occipital plagiocephaly)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
38 Plagiocephaly - March 2010
Patients diagnosed with positional plagiocephaly should be managed within Primary Care.

Helmets (cranial moulding device) will not be eligible for NHS funding unless patients have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need the Consultant is to apply for funding, please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Primary Hip Joint Replacement
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
32 Hip Referrals and surgery - Feb 2016
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Primary Knee Replacement surgery due to osteoarthritis
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
Bedfordshire and Hertfordshire Priorities Forum Statement
33 Knee referral and surgery - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Referral for Hip Joint Replacement Revision Surgery
Procedure Not Routinely Funded Locally
Referral PathwayNHS England commissions all revisions of hip replacement as detailed in the NHS England Specialised Orthopaedics (Adult) service specification D10 (2013).

‘The following specialised orthopaedic services should be provided by appropriately trained multi-disciplinary teams (MDTs) at specialist centre or hub provider through networks which have a critical mass to ensure that the right clinical skills and expertise are in place to ensure excellent outcomes: Secondary or tertiary referred revisions; primary revision (all stages); infected revision; replacement requiring modular prosthesis; massive acetabular defects requiring bone grafting or metal augmentation; complex femoral reconstructive segmental reconstruction’.

Hip replacement revision surgery outside this service specification is not routinely funded at a local Provider. Therefore all patients must be referred to the specialist centre without delay and consideration for these patient's to be treated locally is not an option at this time.
Referral for knee Joint Replacement Revision Surgery
Procedure Not Routinely Funded Locally
Referral PathwayNHS England commissions all knee revision surgery as detailed in the NHS England Specialised Orthopaedics (Adult) service specification D10 (2013).

'The following specialised orthopaedic services should be provided by appropriately trained MDTs at specialist centre or hub provider through networks which have a critical mass to ensure that the right clinical skills and expertise are in place to ensure excellent outcome.

Partial knee replacement, infected joint replacement; all revision joint replacements; autologous chondrocyte transplant of the knee;
failed ligament reconstruction of the knee; failed osteotomy / complications of osteotomy; complex patella / femoral dysfunction.
See Appendix B for further detail.'

Knee Joint replacement surgery outside of this service specification is not routinely funded at a local Provider. Therefore all patients must be referred to the specialist centre without delay and consideration for these patient's to be treated locally is not an option at this time.
Referral for ultrasound-guided corticosteroid injections
This policy does not apply to patients under the age of 18, patients having treatment as part of the management of pain due to cancer or patient with inflammatory arthritides
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
74 - Referrals for ultrasound-guided corticosteroid injections - February 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Removal of excess skin and body contouring (including: reconstruction/revision of body (excess skin removal all areas), post bariatric surgery/ weight loss, buttock, thigh, arm lifts, including abdominoplasty and apronectomy)
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
68 Removal of excess skin - body contouring - May 2016
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care. These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
Aesthetic Surgery Form - Excess skin removal
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Reversal of sterilisation - Male and Female
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
03 Reversal of sterilisation - May 2015
GP to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment.

These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Rhinoplasty
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
71a Septoplasty, rhinoplasty and septorhinoplasty - April 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Nose reshaping Form
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Scotopic Sensitivity Syndrome (Mears-Irlen Syndrome) and coloured filtered / tinted lenses
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
37 Scotopic Sensitivity Syndrome (Mears-Irlen Syndrome) and coloured filters / tinted lenses- Feb 2012
GP/Consultant to apply for funding.
The provision of Mears-Irlen Lenses or other coloured filters/tinted lenses is not routinely funded and prior approval is always required from the IFR service.

These patients must have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following:
General Funding Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Septoplasty, Extracorpeal (Open) Septoplasty

Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
71a Septoplasty, rhinoplasty and septorhinoplasty - April 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Nose reshaping Form
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Extracorporeal septoplasty for revision of deviated septum is considered experimental and investigational, because its effectiveness for this indication has not been established. This would only be funded by research and development budgets as part of a clinical trial.
Septorhinoplasty
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
71a Septoplasty, rhinoplasty and septorhinoplasty - April 2017
GP/Consultant to apply for funding.
This procedure is not routinely funded and prior approval is always required from the IFR service prior to referral and treatment in secondary care.

These patients must have completed the full NHS pathway in primary care and have a strong case on grounds of an exceptional health need. If there is a strong case of exceptional health need please fully complete the following form:
Nose reshaping Form
Email the completed form to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Simultaneous Joint Replacement Surgery
- including hip, knee or shoulder joints
Procedure Not Routinely Funded
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
87 - Simultaneous Joint Replacement Surgery - February 2018
NEW
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Shoulder Arthroscopy
including sub-acromial decompression, impingement, labral tears, rotator cuff repair, adhesive capsulitis and non-traumatic joint instability
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
78 - Shoulder Arthroscopy - June 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Surrogacy
Procedure Not Routinely Funded
Bedfordshire and Hertfordshire Priorities Forum Statement
22 Surrogacy - Feb 2012
Surragacy will not be funded on the NHS.
Thermal radiofrequency denervation of lumbar and cervical facet joints
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)


Bedfordshire and Hertfordshire Priorities Forum Statement
55 Back Injections the elective use of epidural and facet joint injections and denervation of facet joints in management of back pain - April 2017
GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Tonsillectomy in children and adults
Procedure that requires Prior Approval
Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum Statement
24 -Tonsillectomy in children and adults - April 2017


GP to apply for funding.
All cases require prior approval from the IFR service before referral and treatment in secondary care.

Please fully complete the following:
Tonsillectomy Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.

Link to Shared Decision Making Recurrent sore throat decision aid
Topical Negative Pressure (TNP) for wound closure - (vacuum-assisted wound closure (VAC)
Procedure Funded Subject to Audit
Bedfordshire and Hertfordshire Priorities Forum Statement
27 Topical Negative Pressure (TNP) for Wound Closure - Feb 2012
Prior approval is not required where patient meets the criteria in full.

This intervention will be audited as per the contract audit process, Consultant to apply for funding if outside of criteria.
Trigger Finger - Surgical treatment
Procedure that requires Prior Approval
from the Bedfordshire MSK service (Circle Bedfordshire)
36 Carpal tunnel syndrome, Dupuytren's contracture and Trigger Finger - March 2014GP's must refer all patients directly to the Bedfordshire MSK service for assessment and treatment https://www.circlehealth.co.uk/msk/bedford/msk-gp-information/.

GP's must not refer outside of this pathway.

Note to Providers: Please liaise with Bedfordshire MSK service (Circle Bedfordshire) to ensure funding approval is in place.
Varicose Vein Surgery
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
9 Varicose Vein Surgery - Sept 14
GP/Consultant to apply for funding.
All cases require prior approval for this intervention from the IFR service before referral and treatment.

Please fully complete the following
Varicose Vein Form
and email it to the IFR service at Beds.IFRrequests@nhs.net for consideration.
Video capsule endoscopy endoscopy and balloon enteroscopy
Procedure that requires Prior Approval
Bedfordshire and Hertfordshire Priorities Forum Statement
43 Video capsule endoscopy and balloon enteroscopy - November 2016

 

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