Bunions Matt Rogers Transformation Programme Manager Enfield Clinical Commissioning Group MR v01 Bunions Approach Performed a review across a number of CCGs in order to assess the variation in provision of access between Enfield North Central London and other CCGs as follows ID: 704068
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Slide1
Adherence to Evidence Based Medicine Bunions
Matt Rogers, Transformation Programme Manager
Enfield Clinical Commissioning Group
MR v01Slide2
Bunions – ApproachPerformed a review across a number of CCGs in order to assess the variation in provision of access between Enfield, North Central London and other CCGs as follows:
North West London CCGNorth East Essex CCGSouth East London CCG
Cambridgeshire CCGBerkshire CCGOthersCollated evidence on eligibility criteriaData analysis including:Activity & SpendTrend Analysis Benchmarked Enfield CCG data against North East London CCGs, standardised per 1,000 populationSlide3
Bunions – Activity & SpendActivity 2015/16
62
Cost 2015/16£173,631ENFIELD CCG DataSlide4
Bunions – Activity & Spend – Trend AnalysisSlide5
Bunions – Benchmarking
Enfield CCGNCL CCGs
BHR CCGsWELC CCGsBunions (Hallux valgus) surgery£151.3£105.9£97.1£72.8Spend Standardised Per 1,000 PopulationSlide6
Bunions– Policy/Criteria Comparison
NICE Guidance states: In hallux valgus (Bunion) the big toe is deviated towards the other toes and a bony protrusion (a bunion) is formed by medial deviation of the first metatarsal phalangeal joint. There may be damage to the skin over the bunion, pain when walking, cosmetic concerns and difficulty with footwear.2.1.2 Conservative treatment may include footwear modification, and use of insoles or toe spacers. Common surgical treatment options involve different types of first metatarsal osteotomy.
2.2 Outline of the procedure2.2.1 Surgical correction of hallux valgus using minimal access techniques is carried out with the patient under local or general anaesthesia and with X-ray or endoscopic monitoring. One or more small incisions are made close to the hallux metatarsophalangeal joint. The bunion is removed and the metatarsal is divided surgically. The bone fragments may be stabilised using plates, screws or wires. A dressing or plaster may be used to support the foot in the corrected position until the divided bone heals
ENFIELD
NCL
Other CCGs
Organisation
Eligibility
Criteria Exists
BARNET
CCG
N
HARINGEY
CCG
N
ISLINGTON CCG
N
CAMDEN CCG
N
Organisation
Eligibility
Criteria Exists
Dorset CCGYBristol CCGYGloucestershire CCGYBasildon & Brentwood, Southend, Castle Point & Rochford, and Thurrock CCGsY
Organisation
Eligibility
Criteria ExistsEnfield CCGN
Enfield CCG has not adopted a policy / criteria
for elective Bunions surgery