Betsi Cadwaladr University Local Health Board ... - Health in Wales

arrangements for specialist commissioning under the Welsh Health Specialised
Services Committee (WHSSC). However, as these arrangements have not yet been
finalised, it is assumed that any funding requests for services currently commissioned
by HCW will continue to be processed by HCW. This will be until such time that the
new arrangements for tertiary services are in place at which point this procedure will
be amended accordingly.
Extra Contractual Referrals (ECR)
1.8 Treatments or Services provided by an independent or private health service
provider are termed extra contractual referrals or ECR.
Non Contracted Activity (NCA)
1.9 Treatments or Services provided by other NHS organisations with which the
Local Health Board does not hold an existing Long Term Agreement (LTA) or
contracts, are termed non contracted activity or NCA.
1.10 Elective and non emergency NCAs need prior authorisation from the LHB and
should be considered on an individual case by case basis. However, emergency or
immediately necessary treatments do not need prior authorisation from the LHB and
although these tend to be low volume, they are funded from current LHB revenue and
so therefore present an in-year financial risk for the LHB.
Named Patient Contacts (NPC)
1.11 Treatments or Services by an NHS organisation which is prepared to provide a
specific treatment/service outside the normal LHB contracts are termed Named
Patient Contacts or NPC. This mechanism may be used where a provider is
unwilling, or it is inappropriate, to use the NCA process because of high and/or
variable costs involved. This will often apply to specialised services or new services
being offered by the NHS organisation.
Named Patient Variations (NPV)
1.12 Treatments or Services by an NHS organisation which are variations to an
existing LTA or contract and which may involve additional funding to support
enhanced service levels/treatments to individual patients are termed Named Patient
Variations (NPV)
Low Effectiveness Procedures (LEPs)
1.13 Appendix 1 lists clinical interventions of limited or unknown clinical value.
These interventions are routinely considered to be of low priority and are not normally
used by the NHS. These interventions have been split between those that should not
be used in any circumstance and those that should not be used except under strict
criteria. The latter are subdivided between lower volume (20/year) treatments, according to an analysis across North Wales
undertaken in 2009 by Public Health Wales 1 . Where applicable the specific
circumstances/strict criteria under which use can be considered by the UHB, are set
out together with reference links to the available evidence. Procedures will be subject
to the process outlined in Section 3 of this policy. In addition, it will be necessary for
procedures of higher volume to be subject to investigation and continuous review to
ensure that the UHB position and interpretation of evidence continues to be
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