View 2019 Abstracts

To examine variability of Clinical Commissioning Group-imposed funding restrictions and access policies for oculoplastic procedures in England.

A freedom of information request was sent to all 206 CCGs seeking information about their funding policies for common oculoplastic procedures. Questions included who was involved in policy creation, which procedures are restricted and what access criteria apply. When signposted to online policies, these were reviewed.

All CCGs responded. Blepharoplasty is the procedure most frequently restricted, 198 CCGs having relevant policies. Of these, about half approve surgery by criterion based access (CBA), half via prior approval (PA). Ectropion repair is the most variably funded, with 119 CCGs having policies, of which 34% have unrestricted access, 27% CBA, 34% PA. 193 CCGs restrict access to benign skin lesion treatment, but only 18 (9%) have specific periocular policies. Significant funding variation also exists for all other procedures examined. Access criteria usually depend on impact on visual function, but some CCGs made additional allowance for specific aetiologies. Some groups of CCGs have adopted shared policies. Only 7% of CCGs confirmed specific oculoplastic involvement in policy design. An additional 11% reported involvement of eye care professionals. Although many policies are publicly available online, the authors found many to be unclear and suspect practical implementation may be challenging.

Access policies vary significantly across England. Practical interpretation can be difficult for clinicians, perhaps due to lack of oculoplastic involvement in policy design. This leads to a ‘postcode lottery’ with implications for patient access and GP and surgeon workload.