North London Partners in health and care

PoLCE FAQs


What is the aim of the Procedures of Limited Clinical Effectiveness (PoLCE) policy?

The aim of PoLCE policy is to make sure that the care provided in north central London (NCL) is evidence-based and will achieve the best clinical outcomes and experience for local residents. We want everyone living in NCL to have fair and equal access to treatment and make the best use of our resources.

The policy update makes sure that we have a consistent approach to delivering care based on the latest research and guidance. This will achieve the best outcomes and experience for patients.

Treatments included in the policy fall into three categories:

  • Clinical best practice: when a patient reaches the clinical threshold they are referred for treatment – treatment for hips, knees and cataracts fall into this category.
  • Ensuring we only fund treatments with evidenced impact: Some procedures lack the highest category of evidence to show how they will benefit our residents. These treatments are not routinely funded. However, a patient and their GP can make an Individual Funding Request to be considered by a clinical panel to and it may be funded.
  • Ensuring outdated techniques are not undertaken: where evidence shows procedures are outdated and maybe harmful, we do not provide funding.

Yes, in north central London we estimate that the number of orthopaedic procedures (knee and hip procedures) will increase by 2.2% by 2023, that is an average increase of 0.38% a year.

Our policy sets out clinical best practice pathway for hips and knees. This ensures other less invasive treatments have been discussed with you and if appropriate tried, before a referral on to an operation.

This will mean you have a conversation with your GP to jointly agree it is the right time for an operation, based on your symptoms and individual situation and a joint decision about being referred for the procedure.

Yes, the policy reflects current best practice and anyone who meets the clinical criteria now and in the future will continue to be referred for cataract surgery, if they wish to be.  We are planning that cataract procedures commissioned in NCL will continue to increase over the next five years.

We are changing the name of the policy because residents, community groups, local Healthwatches have told us that the name is confusing and doesn’t accurately describe what the policy does. We want to be clear about what the policy update includes, what the purpose is and what this will mean for people living in NCL. 

Treatments included in the policy fall into three categories:

  • Clinical best practice: when a patient reaches the clinical threshold they are referred for treatment – treatment for hips, knees and cataracts fall into this category.
  • Ensuring we only fund treatments with evidenced impact: Some procedures lack the highest category of evidence to show how they will benefit our residents. These treatments are not routinely funded. However, a patient and their GP can make an Individual Funding Request to be considered by a clinical panel to and it may be funded.
  • Ensuring outdated techniques are not undertaken: where evidence shows procedures are outdated and maybe harmful, we do not provide funding.

We have had a policy in place since 2015. There have been some recent additions to it. These are listed below in the categories of the types of procedure.

Procedures are categorised along three lines:

  • Clinical best practice - funded when clinical threshold met
  • Evidence impact - Individual Funding Request required
  • Outdated technique -not funded

Clinical best practice - funded when clinical threshold met 

  • Knee arthroplasty (replacement)
  • Hip arthroplasty (replacement)
  • Cataract surgery (replacing a clouded eye lens with an artificial lens)

Evidence impact - Individual Funding Request required

  • Breast Reduction
  • Removal of benign skin lesions
  • Grommets
  • Tonsillectomy
  • Haemorrhoid Surgery
  • Hysterectomy for heavy bleeding
  • Chalazia Removal
  • Shoulder decompression
  • Carpal tunnel syndrome release
  • Dupuytrens contracture release
  • Ganglion excision
  • Trigger finger release
  • Varicose vein surgery

Outdated technique -not funded

  • Intervention for snoring (not OSA)
  • Dilatation and curettage for heavy menstrual bleeding
  • Knee arthroscopy with osteoarthritis
  • Injection for non-specific low back pain without sciatica

If a treatment cycle for a procedure is underway, it can be completed, but if the technique falls in the ‘outdated techniques’ category then no further cycles of treatment will be offered.

 

If you have been referred for a treatment before April 2019 you will still receive it as agreed with your healthcare professional.

Across Barnet, Camden, Enfield, Haringey and Islington, we currently spend over £2 billion a year on health services. The £2m saving projected from the work related to PoLCE policy update 2019 is less than 0.1% of this.

Any savings will continue to be spent on health services, but will be focused on providing treatments where we know there is best evidence of improved outcomes for patients.

Some procedures, such as plastic surgery, lack evidence that they will benefit our residents and these treatments will not be routinely funded. If there are exceptional circumstances that mean it should be funded in specific circumstances. The patient and GP must make an Individual Funding Request which will go to a clinical panel to be considered and treatment may be funded in some circumstances

Our policy needs to be updated regularly to make sure we reflect the latest clinical practice.

We will publish information about future reviews on this website, www.northlondonparnterns.org.uk and share it with CCGs, local Healthwatches and local community groups.

For further information email the mailbox nclstppmo@nhs.net , in subject line please add “PoLCE policy query