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

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OPCS Condition Criteria Source of advice Remarks T59.- T60.- D15.1 Ganglia – Surgical Removal Grommets - Drainage of middle ear in otitis media with effusion (OME) skin or lid margin. Should NOT be used EXCEPT if the ganglion is very painful and restricts work and hobbies (subject to specialist surgical assessment and advice). Should NOT be used EXCEPT where: There has been a period of at least three months watchful waiting from the date of the first appointment with an audiologist or GP with special interest in ENT AND the child is placed on a waiting list for the procedure at the end of this period; AND OME persists after three months AND the child (who must be over three years of age) suffers from at least one of the following: • At least 3-5 recurrences of acute otitis media in a year • Evidence of delay in speech development • Educational or behavioural problems attributable to persistent hearing impairment, with a hearing loss of at least 25dB particularly in the lower tones (low frequency loss) • A significant second disability such as Downs syndrome Public Health Wales Evidence-Based Information http://www2.nphs.wales.n hs.uk:8080/healthservice qdtdocs.nsf/PublicPage? OpenPage NICE clinical guideline 60 http://www.nice.org.uk/nic emedia/pdf/CG60fullguid eline.pdf The evidence suggests that there is a high rate of spontaneous resolution for ganglia and that reassurance should be the first therapeutic intervention for most patients and all children Insertion of grommets is one of the five surgical procedures that the Department of Health monitors as indicators of excess surgical activity. 48
OPCS Condition Criteria Source of advice Remarks H51.- H52.- Q10.3 Q10.8 Q10.9 Q07.- Q08.- Haemorrhoidectomy Heavy Menstrual Bleeding - Dilation and curettage (D&C)/ Hysteroscopy Heavy Menstrual Bleeding - Hysterectomy Should NOT be used EXCEPT in cases of: • Recurrent haemorrhoids • Persistent bleeding • Failed conservative treatment D&C should NOT be used as a therapeutic treatment or as a diagnostic tool for heavy menstrual bleeding so will not receive prior approval for these conditions. Hysteroscopy should NOT be used EXCEPT when it is carried out: • As an investigation for structural and histological abnormalities where ultrasound has been used as the first line diagnostic tool and where the outcomes are inconclusive • When undertaking endometrial ablation Should NOT be used EXCEPT when: • Other treatment options have failed, are contraindicated or are declined by the woman • There is a wish for amenorrhoea • The woman (who has been fully informed) requests it Public Health Wales Evidence-Based Information http://www2.nphs.wales.n hs.uk:8080/healthservice qdtdocs.nsf/PublicPage? OpenPage NICE Clinical Guideline 44 http://guidance.nice.org.u k/CG44 NICE Clinical Guideline 44 http://guidance.nice.org.u k/CG44 The evidence suggests that first and second degree haemorrhoids are classically treated with some form of nonsurgical ablative/ fixative intervention, third degree treated with rubber band ligation or haemorrhoidectomy, and fourth degree with haemorrhoidectomy. Dilation and curettage is one of the five surgical procedures that the Department of Health monitors as indicators of excess surgical activity. Hysterectomy is one of the five surgical procedures that the Department of Health monitors as indicators of excess surgical activity. 49
Page 1 and 2: Betsi Cadwaladr University Local He
Page 3 and 4: Section 1 - Introduction and Defini
Page 5 and 6: consistent and appropriate. This wi
Page 7 and 8: The default position should be that
Page 9 and 10: Section 3 - Funding Application Pro
Page 11 and 12: efficacy; in doing so the Chief of
Page 13 and 14: 3.24 Any recommendation made by the
Page 15 and 16: A copy of the best practice guidanc
Page 17 and 18: 6.4 On receipt of this corresponden
Page 19 and 20: Section 8 - Communications Strategy
Page 21 and 22: APPENDIX 1 LOW EFFECTIVENESS PROCED
Page 23 and 24: OPCS Condition Criteria Source of a
Page 25 and 26: OPCS Condition Criteria Source of A
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Page 56 and 57: Available at: http://www2.nphs.wale
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Page 60 and 61: Questions Comments / Explanation (m
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Page 64 and 65: Has the application been approved b
Page 66: Date of IPC Panel For LHB Use Only

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