Table 1 Extract from IFR panel email discussion about Jack’s case of gynaecomastia (site A)
From | To | Email text |
|---|---|---|
Asst Director Public Health | Commissioning Manager | Please circulate my view, thanks. We would normally refuse to fund this as it’s a cosmetic procedure, however we need to be sure about the following points: |
• significant adverse effect on activities of daily living | ||
• significant disfigurement and I think should request further information on these, in particular the first one. I also think we should seek the [Assistant Director of Children’s Commissioning] views since this request is for a 14 year old child. | ||
Chair of IFR Panel | Director of Commissioning cc Panel | Could you have a look at this, please. I’m not sure that it’s a contract exclusion and I wonder if it should be covered by PbR [Payment by Results]. |
Breast reduction is normally something done to women with big breasts. The patient here is a young male with an unusual condition called gynaecomastia. This usually occurring in early adolescence and is a potential exception under the sector’s low priority treatments policy. | ||
If this were a contract exclusion then I’d say we could not fund it at present on affordability grounds, but I wonder if it could be classified as something under PbR and would not be considered to be a contract exclusion? | ||
Happy to discuss further. | ||
Director of Commissioning | Chair of IFR Panel; cc Panel | I do not believe it is covered under PbR. I can find no reference to this under PbR. The consultant has also mentioned in his letter that it is cosmetic. We also have to bear in mind if [NHS hospital trust] carried out a procedure on a child they could apply a 78% uplift for the procedure from the adult tariff. |
Chair of IFR Panel | Director of Commissioning; cc Panel | Thanks. If the consultant says that this is cosmetic and it’s not covered under PbR then we must decline to fund this on affordability grounds and because of the low priorities treatment policy (noting that gynaecomastia is a potential exceptional circumstance in this policy). |
Assnt Dir. of Finance | Panel | I consider this cosmetic and therefore suggest that we do not fund this. |
Director of Nursing | Panel | Although I appreciate that this is very problematic for the individual this particular request is as outlined by the consultant surgery for cosmetic reasons therefore I suggest that we do not fund this particular request. |
Public health specialist | Panel | I agree not to fund this procedure for cosmetic reasons. |