NHSCC and NHS England launch consultation on commissioning guidance for ineffective and risky treatments

Today the NHS England board approved proposals to launch a consultation on a range of treatments as part of the Evidence-Based Interventions programme. Working in collaboration with NHS England, NICE, CQC, the Academy of Medical Royal Colleges and the relevant Royal Colleges, this is an important area of work for commissioners and the wider health system, which will identify current NHS spend that could be better utilised for higher priority areas, such as primary care and mental health.

Today’s consultation launch is the first step in this new programme which aims to curb waste, free up resources and prevent unnecessary pain and inconvenience to patients. Looking at an initial list of 17 treatments and procedures it is hoped that we can avoid more than 100,000 unnecessary procedures a year and free up around £200 million that can be spent on more effective care.

This work builds on similar joint consultations over the past year which resulted in commissioning guidance on items which should not routinely be prescribed in primary care and conditions for which over the counter items should not routinely be prescribed in primary care.


Graham Jackson - board meetingDr Graham Jackson, NHSCC co-chair, said: “We are pleased to partner with NHS England, AMoRC, NHSI, NICE and CQC on this important consultation. This is the start of an ambitious programme of evidence based work to focus on a range of interventions that should not be provided or only provided on the NHS in certain circumstances.

“There have been a number of attempts to implement this before but this is the first time we have had a national clinical consensus across commissioners, providers and national bodies to make sure the procedures we are offering on the NHS are safe for patients, deliver good outcomes and, are both clinically and cost-effective in order to secure the very best value for the limited NHS pound.

“It is important that we have an honest conversation with the public, patients and clinicians about what can be expected from the NHS within the constrained funds it has available.”

Steve-Powis-150x150NHS England National Medical Director Professor Steven Powis said:

“If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits. By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.”

Respond to the consultation

You can read the full consultation document here, and there are further documents and FAQ’s on the NHS England website.

The consultation period will run from 4th July to 28 September, and we would like as many people as possible to respond and feed in their views. There are a number of ways you can do that:

Full list of interventions

The Evidence-Based Interventions programme will consider 17 treatments and procedures, with four proposed to be offered only when a patient makes an individual request:

  • Snoring surgery
  • Dilatation and curettage for heavy menstrual bleeding
  • Knee arthroscopies for osteoarthritis
  • Injections for non-specific back pain

Thirteen further interventions are being proposed only to be offered when specific criteria are met:

  • Breast reduction
  • Removal of benign skin lesions
  • Grommets for Glue Ear
  • Tonsillectomy for sore throats
  • Haemorrhoid surgery.
  • Hysterectomy for heavy menstrual bleeding
  • Chalazia (lesions on eyelids) removal
  • Anthroscopic compression for subacromial shoulder pain
  • Carpal tunnel syndrome release
  • Dupuytren’s contracture release
  • Ganglion excision
  • Trigger finger release
  • Varicose vein surgery

The National Institute for Clinical Excellence (NICE), which advises on the clinical benefits and cost-effectiveness of treatments, has recommended that many of the procedures should be used as a last resort or even not at all, due to harmful side-effects.

While the procedures will not be banned outright, NHS England wants to ensure that they are carried out only where there is compelling evidence that they will benefit patients. In most of the 17 interventions to be considered, alternative treatments like physiotherapy, a minor injection or change of diet are likely to be effective. Any patient at risk of serious harm from their condition will continue to be offered treatment, and medical professionals will continue to follow guidelines from NICE when recommending treatment.

4 July 2018