Experts believe that certain routine treatments have only limited or temporary benefit. These treatments are referred to as ‘Procedures of Limited Clinical Value’ (PLCV). In many cases, there are alternative treatments that are more effective and some of the more traditional procedures will have been replaced by modern techniques.

We are reviewing these procedures because we believe that more needs to be done to make sure that such treatments are not routinely performed, or only performed in specific circumstances. This review also gives us the perfect opportunity to standardise the commissioning policies for the treatments. By reducing the unnecessary variation that currently exists in the area, we can make sure that people can access the same treatment for the same reasons, wherever they live in West Yorkshire and Harrogate.

The outcome of this work plan will be that, instead of having a procedure of limited clinical value, patients would be offered a better alternative.

There may be cases when a GP or consultant believes that a patient would benefit from a PLCV rather than an alternative. In such cases, the individual funding request (IFR) process can be followed to potentially apply for the treatment to be funded. Each request for treatment would be considered on a case-by-case basis.

As part of this work to reduce unnecessary medical procedures, we have adopted NHS England’s Evidence-Based Interventions (EBI) policy which will be implemented across West Yorkshire and Harrogate. The policy aims to prevent avoidable harm to patients by making sure that treatments routinely available on the NHS are appropriate and clinically effective. The EBI policy will ensure that people who would benefit from one of these ‘traditional’ procedures are offered them but for most people, there is a safer and less invasive alternative. Read more about the EBI policy, and the 17 procedures it covers, here.

The demand for orthopaedic and MSK services continues to increase year on year which has resulted in the budget for these services being one of the largest in the NHS. 

There’s no doubt that this rise in demand will continue, particularly as we have an ageing population, so we must address this concern and make positive changes that focus on patients’ needs. 

By providing more integrated care, and reducing the number of unnecessary follow-up appointments, we can maximise capacity to reduce waiting times and make sure we have sustainable orthopaedic and MSK services for years to come.

In addition to transforming orthopaedic and MSK services, we are working in partnership with hospitals and service providers to reduce variation in the way those services are delivered in West Yorkshire and Harrogate. By having standard patient pathways and policies, we can remove the ‘postcode lottery’ and variation that currently exists.

We have developed a new MSK pathway that sets out the various steps in the care of people referred onto MSK services by their GP or other healthcare professional.

As part of this work, we have adopted NHS England's Evidence-Based Interventions (EBI) policy which aims to reduce unnecessary medical procedures and prevent avoidable harm to patients by making sure that treatments routinely available on the NHS are appropriate and clinically effective. The EBI policy covers 17 procedures, some of which are related to muscles, joints and bones such as knee arthroscopy, injections for non-specific low back pain and shoulder decompression. The EBI policy will ensure that people who would benefit from one of these ‘traditional’ procedures are offered them but for most people, there is a safer and less invasive alternative. Read more here.

Eye care services don’t always have to be delivered in hospitals and many can be safely delivered at local clinics or high street opticians for example. By adjusting how and where eye care services are delivered, we can make the best use of the expertise we already have in our communities and move some services out of hospitals and into local settings. This is usually much easier and more convenient for the patient - and often less daunting.

We do have a great deal of expertise when it comes to eye health services in West Yorkshire and Harrogate, from eye surgeons to visual impairment rehabilitation officers. This handy guide to who works in eye health has been produced by VisionUK and explains the different roles, where they are based and what services they offer.

It’s a shocking fact that around half of all sight loss is preventable, and many people are unaware that smoking, obesity, diabetes and high blood pressure can all contribute to avoidable sight loss. One key aspects of our eye care work will be to support and promote eye health, sight checks and the use of medicines where appropriate to reduce people’s risk of sight loss.

People with learning disabilities are much more likely to have serious sight problems than others so it's really important that everyone with a learning disability has regular eye tests. SeeAbility supports better eye care for people with learning disabilities. There is an introduction to eye care for adults and children with learning disabilities on the charity's website here.

We all know that our eyesight tends to get worse as we get older but this doesn’t always have to be a done deal and help is available. We are assessing the support that is currently available in West Yorkshire and Harrogate to make sure it is as good as it can be.

People who are referred onto planned care services will be encouraged and supported to make healthier choices such as stopping smoking, losing weight or becoming more physically active. These lifestyle changes will help to improve their health in case they need an operation. 

In some cases, the result of such lifestyle changes could mean that an operation is no longer needed and if it is, being in better shape will give patients the best possible chance of a good outcome from their surgery.

Of course it’s much better for everyone if people live healthier long before they may need to access healthcare. To support this, we are working with colleagues from social care, public health, housing and community organisations to direct people to local services that could help them get started on those lifestyle improvements that will make a real difference now and in the future.

By supporting people to make healthier choices and prevent avoidable conditions we can improve the health of the population and, in the longer term, reduce the demand on some planned healthcare services. This will release money that can be used to good effect elsewhere in the NHS.

We want to identify and address unwarranted variation and waste in prescribing. To do this, we must make sure that the same criteria apply throughout West Yorkshire and Harrogate by introducing a standard prescribing policy for CCGs to implement. Everyone should have the same access to the same treatments, including when new medicines become available on the NHS. 

We are already very efficient in relation to prescribing and achieving best value from our medicines budgets, but there are still opportunities to improve. We will continue to reduce the prescribing of medicines that have little evidence to show that they work well, and medicines that can be bought ‘over-the-counter’ such as paracetamol and antihistamines for short term use.