Carpal Tunnel Syndrome Surgery Policy 1
VERSION CONTROL Version: 3.0 Ratified by: NHS Warwickshire Nth Governing Body Date ratified: 1 September 2016 Name of iginat/auth: Name of responsible committee: Joint CCG Clinical Commissioning Policy Development Group Commissioning, Finance and Perfmance Committee Date issued: 1 September 2016 Review date: 1 September 2019 VERSION HISTORY Date Version Comment / Update April 2009 1.0 Previous PCT policy June 2013 2.0 Version to Governing Body approved on 12 June 2013 3.0 2
Treatment Indication Funding Status OPCS Code Treatment: Carpal Tunnel Syndrome Surgery Carpal Tunnel Syndrome Pri Approval Management and treatment should be in accdance with British Society f Surgery of the Hand (BSSH), British Orthopaedic Association (BOA), Royal College of Surgeons of England (RCSEng) Commissioning guide 1 Refer to secondary care provider if: Moderate to severe deteriating symptoms Daily symptoms, frequent night waking Persistent symptoms causing functional impairment not responding to 12 weeks of evidence based non-surgical treatments; this time to include treatment received in primary care Management: Providers should adopt a shared decision making model, define treatment goals and take into account the patient s personal circumstances. Patient infmation should be provided by MDT Splints at night Single steroid + local anaesthetic injection if: - not already given in Primary care - painful reversible paraesthesia not helped by splints - when diagnosis is uncertain - when surgery cannot be undertaken safely Physiotherapy median ulnar nerve mobilisation techniques Equality Impact Surgery (open endoscopic) suppted f: Patients with moderate severe carpal tunnel Where conservative management has failed Note: Patients who are not suitable f surgery have decided not to have surgery should be offered an appropriate care package Nerve conduction studies should not be undertaken f patients with unequivocal CTS and only be undertaken f following: - Equivocal clinical examination and histy - Persistent recurrent CTS Ref: 1. Treatment of painful tingling fingers - November 2013 https://www.rcseng.ac.uk/healthcarebodies/docs/treatmentofpainfultinglingfingers.pdf Application and approval via Blueteq, where Blueteq is available, must be completed and will be required befe any treatment proceeds. Where Blueteq is not available, pri approval must be obtained befe carrying out any procedure. See EIA attached 3
Equality Impact Assessment Policy Carpal Tunnel Person completing EIA Date of EIA December 2015 Accountable CCG Lead Clive Campton, Individual Funding Request (IFR) Team Lead Jenni Nthcote, Direct of Partnerships and Engagement Aim of Wk Who Affected To assess the of the policy on all of the protected groups. Warwickshire Nth registered patients Single Equality Scheme Strand Likely to be a differential? Single Equality Scheme Strand Gender No Age No Race No Social deprivation No Disability No Carers No Religion / belief No Human rights No Sexual ientation No Other No Likely to be a differential? Describe any potential known adverse s barriers f protected/vulnerable groups and what actions will be taken (if any) to mitigate. If there are no known adverse s, please explain. The of this policy has been considered against all protected characteristics and Human Rights values. No potential known adverse s barriers f protected and/ vulnerable groups were identified. Clinical Members of the Arden Policy Development Group which oversaw policy revision: Sue Turner Dr Chris Pycock Yadav Deepika Dr Steve Allen Dr Adrian Parsons Kathryn Millard WNCCG Governing Body Member (Practice Netwk Clinical Lead) WNCCG Secondary Care Liaison CRCCG Member of CCG Executive Team, GP CRCCG Governing Body Member (Chief Clinical Officer), GP SWCCG Governing Body Member, GP WCC Public Health Consultant 4
Positive Negative Neutral Risk (I) Risk likelihood (L) Risk Sce (IxL) Quality Impact Assessment QIA Completed By: Sue Turner, WNCCG Practice Netwk Clinical Lead Date Completed: 04 July 2016 CARPAL TUNNEL OUTCOME ASSESSMENT Evidence/Comments f answers Risk rating (F negative outcomes) Mitigating actions AREA OF ASSESSMENT Duty of Quality scheme on any of the following NHS Outcomes Framewk scheme on the delivery of the five domains: Patient services proposal on any of the following: Effectiveness clinical outcome Patient experience Patient safety Parity of esteem Safeguarding children adults Enhancing quality of life Ensuring people have a positive experience of care Preventing people from dying prematurely Helping people recover from episodes of ill health following injury Treating and caring f people in a safe environment and protecting them from avoidable harm A modern model of integrated care, with key focus on multiple longterm conditions and clinical risk facts Access to the highest quality urgent and emergency care Convenient access f everyone Ensuring that citizens are fully included in all aspects of service design and change The Policy has not changed significantly therefe there is no on patients. Treatment is in accdance with British Society f Surgery of the Hand. Wding and fmat of policy has been changed to make clearer. References to mild cases has so that policy is tighter. All patients seen now in same timeframe without early access f particular groups of patients, e.g. those with long-term conditions, the elderly, etc. Patient Choice Patients are empowered in their own care Wider primary care, provided at scale 5