The aim of the Evidence-Based Interventions programme is to prevent avoidable harm to patients, to avoid unnecessary operations, and to free up clinical time by only offering interventions on the NHS that are evidence-based and appropriate.
Using clinical evidence provided by NICE guidelines, Choosing Wisely recommendations, academic studies and local Clinical Commissioning Groups (CCGs) work on Procedures of Limited Clinical Effectiveness (PoLCE) we identified a large number of interventions that could have been included in the programme. Following a number of clinical and equality checks these were shortlisted down to 17 interventions that fall into one of two categories:
- four interventions that should not be routinely commissioned by CCGs or performed, unless a successful Individual Funding Request (IFR) is made (Category 1) either because they are a) ineffective or b) have been superseded by a less invasive or more effective alternative. These interventions are snoring surgery in the absence of Obstructive Sleep Apnoea (OSA), dilatation and curettage (D&C) for heavy menstrual bleeding in women, knee arthroscopy for patients with osteoarthritis and injections for non-specific low back pain without sciatica.
- thirteen interventions that should only be commissioned by CCGs or performed when specific clinical criteria are met (Category 2) – this is because they have only been shown to be effective in certain circumstances. These interventions are breast reduction, removal of benign skin lesions, grommets for glue ear in children, tonsillectomy for recurrent tonsillitis, haemorrhoid surgery, hysterectomy for heavy menstrual bleeding, chalazia removal, arthroscopic shoulder decompression for subacromial shoulder pain, carpal tunnel syndrome release, Dupuytren’s contracture release, ganglion excision, Trigger finger release, varicose vein surgery.