The impact of commissioning for rhinosinusitis in England

Abstract

Objectives:To assess the compliance of clinical commissioning groups (CCG) inEngland with the ENT-UK Rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence.We also aimed to assess the ease of accessibility of data from CCG's.Design:Audit of compliance of English CCG's with the ENT-UK rhinosinusitis commissioning guide. Setting: CCG's in EnglandParticipants: 58 of the 221 CCG's in England were included, chosen because they were the first CCG's authorised by NHS England or alternately, the CCG's forecast to have a deficit in their first year of operation.Their websites were reviewed; when information was not easily accessibly, a freedom of information request was submitted to the relevant CCG. Main outcome measures:Compliance with commissioning guidelines for rhinosinusitis. Results:13% of CCG's had restrictive referral criteria in place,largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanningwithin primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice. Conclusions:Restricting access to surgerymay contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.

Management strategies for chronic rhinosinusitis: a qualitative study of GP and ENT specialist views of current practice in the UK

“…However, knowledge and uptake of the European guideline is understandably variable in UK primary care. An audit of Clinical Commissioning Groups (CCGs) in England found that compliance with CRS commissioning was limited in 13% of CCGs 23. It may be that such guidance is not perceived in the same way that NICE guidance is viewed, affecting management and referral decisions, and fostering the variation of practice reported in this study.…”

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

“…The UK Commissioning guidance for CRS advises against use of long term macrolides in primary care (14). Contrary to this guidance, 12% of CCGs were found to make a recommendation to prescribe long term macrolide antibiotics to patients with symptoms suggestive of CRS prior to referral to secondary care (21). The use of a prolonged course in primary care may therefore reflect local commissioning policies, although it may also occur on recommendation from secondary care after a more extensive investigation.…”

A review of key challenges of electrospun scaffolds for tissue-engineering applications

“…In this regard, hydroxyapatite (HA), the major inorganic component of natural bone, is the most appealing option (Zhang et al, 2007a). For the incorporation of HA into electrospun scaffolds, various approaches, such as blending of HA nano-/microparticles with a polymeric component , incubating electrospun scaffolds in simulated body fluid (SBF) (Baskar et al, 2011) and an alternate soaking method (Jaiswal et al, 2013b), have been used. The alternate soaking method is preferred to blending and simple SBF incubation, as the blending has the risk of non-homogeneous distribution of HA particles in the matrix, and simple incubating is time consuming and elaborating.…”