Second wave of Evidence-Based Interventions

The Evidence-Based Interventions (EBI) programme aims to reduce unnecessary medical interventions and prevent avoidable harm to patients by making sure that tests, treatments and procedures routinely available on the NHS are appropriate and clinically effective. 

In 2018, a public consultation for wave one of the EBI programme received a significant amount of support from patient organisations, commissioners, providers and other representative bodies. It detailed 17 interventions that should no longer be routinely offered on the NHS because they do not work in the vast majority of cases, are only appropriate in certain circumstances or because they have been replaced by safer and less invasive alternatives.

In early 2019, the Partnership agreed to adopt the EBI commissioning policies for all 17 of these interventions. These are now being implemented across West Yorkshire and Harrogate and we are already seeing a significant reduction in the number of inappropriate treatments. 

The huge impact of Covid-19 has reinforced the importance of the EBI programme. As planned care services are restarted across West Yorkshire and Harrogate, clinicians must be able to focus on effective care for those who need it and not on unnecessary interventions.

Engagement around EBI wave two began on 13 July 2020. As with wave one, the interventions selected for wave two have little or no clinical effectiveness based on clinical evidence, research and academic studies. There are 31 tests, treatments and procedures in total for wave two as detailed below.

The following two interventions should no longer be routinely commissioned or offered because they do not work or have been superseded by a safer alternative. In rare circumstances they may be appropriate however so they could be offered if accompanied by a successful Individual Funding Request:

1.  Exercise ECG for screening for coronary heart disease
2. Helmet therapy in the treatment of positional plagiocephaly in children

The guidance includes a further 29 interventions that should only be commissioned or offered when specific clinical criteria are met as they have only been shown to be appropriate in certain circumstances:

3.  Diagnostic coronary angiography for low risk, stable chest pain
4.  Repair of minimally symptomatic inguinal hernia
5.  Surgical intervention for chronic sinusitis
6.  Removal of adenoids
7.  Arthroscopic surgery for meniscal tears
8. Troponin test
9.  Surgical removal of kidney stones
10. Cystoscopy for men with uncomplicated lower urinary tract symptoms
11.  Surgical intervention for benign prostatic hyperplasia
12. Discectomy
13. Radiofrequency facet joint denervation
14. Upper GI endoscopy
15. Appropriate colonoscopy
16. Repeat Colonoscopy
17.  ERCP in acute gallstone pancreatitis without cholangitis
18. Cholecystectomy
19.  Appendicectomy without confirmation of appendicitis
20. Low back pain imaging
21.  Knee MRI when symptoms are suggestive of osteoarthritis
22. Knee MRI for suspected meniscal tears
23. Vertebroplasty for painful osteoporotic vertebral fractures
24. Imaging for shoulder pain
25. MRI scan of the hip for arthritis
26. Fusion surgery for mechanical axial low back pain
27. Pre-operative chest x-ray
28. Pre-operative ECG
29. Prostate-specific antigen (PSA) test
30.  Liver function, creatinine kinase and lipid level tests – (Lipid lowering therapy)
31.  Blood transfusion

The Expert Advisory Committee (EAC) is gathering the views and opinions of patients, the public, key stakeholders and other interested parties, as well as providers and commissioners of these 31 tests, treatments and procedures from across health systems. Its engagement exercise is now available for responses via the Academy of Medical Royal Colleges website here to run for six weeks until 24 August 2020.  

As well as the opportunity to submit an online response via a survey, and/or a more open submission via email, a series of webinars will take place in August. These will cover interventions by specialty and data-related issues. In addition, the Patients Association will be running three patient focused workshops on the guidance.

After 24 August 2020, the EAC will analyse the responses and submit a final recommendation on whether the interventions should be adopted by the EBI programme. The Partnership would then consider this recommendation and potential adoption of the wave two proposals for West Yorkshire and Harrogate.

West Yorkshire and Harrogate Health and Care Partnership is hosted by NHS Wakefield Clinical Commissioning Group.
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