Lavender Statements

The local commissioning policies (Lavender statements) listed on this page have been developed by Oxfordshire Priorities Forum and the MOBBB Priorities Committee on behalf of NHS Oxfordshire. NHS organisations caring for Oxfordshire patients must take account of these statements when considering treatment or referral to other specialists.

In particular, health care providers should note that interventions given a 'LOW PRIORITY' are not normally commissioned by NHS Oxfordshire. For information about applying to the PCT for individual funding for 'low priority' interventions, see Individual Patient Treatment Requests.

Please contact NHS Oxfordshire's Health Care Priorities Team on (01865) 336887 or email priorities.oxfordshirepct@nhs.net for all enquiries about Lavender statements. A list of withdrawn statements is also available on this site.

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Medicines and Vaccines

Ref # Policy Title Last Updated Primary Care Secondary / Specialist Care Referral Guideline Available*
220 Breast Cancer - Bisphosphonate therapy (62KB) Feb 2012 Yes Yes No
218

Multiple sclerosis (exacerbations) - intravenous versus oral steroids (20KB)

 Jan 2012 No Yes No
217

Breast cancer (HER2 positive) - reintroduction of trastuzumab in patients with cancer progression (31KB)

 Dec 2011 No Yes No
216

Breast cancer (HER2 positive) - reintroduction of trastuzumab for patients previously treated for early breast cancer (23KB)

 Dec 2011 No Yes No
215

Crohn’s disease in children (active severe) - dose escalation (infliximab and adalimumab) (27KB)

 Dec 2011 No Yes No
214

Crohn’s disease (active severe) - dose escalation (infliximab and adalimumab) (27KB)

 Dec 2011 No Yes No
213

Crohn’s disease (active fistulising) - dose escalation (infliximab and adalimumab) (26KB)

 Dec 2011 No Yes No
212

Retinal vein occlusion (RVO) -anti-VEGF and dexamethasone implant (22KB)

 Dec 2011 No Yes No
211 Diabetic macular oedema - anti-VEGF and other drugs (23KB) Dec 2011 No Yes No
208 Cetuximab for PS208 Cetuximab in colorectal cancer (15K) Aug 2011 No Yes No
207 Rituximab for mantle cell lymphoma (15KB) Aug 2011 No Yes No
201

Rheumatoid arthritis - biological therapies (29KB)

 May 2011 No Yes Yes
198 Temozolomide for recurrent glioblastoma multiforme (15KB) Mar 2011 No Yes No
197 Degarelix for prostate cancer (15KB) Mar 2011 No Yes No
196 Pulmonary hypertension - pharmaceutical treatments (17KB) Jan 2011 No Yes No
195 Dabigatran for stroke and systemic embolism prevention in patients with atrial fibrillation (15KB) Jan 2011 Yes Yes No
194 Palivizumab for RSV prevention in pre-term infants (61KB) Jan 2011 Yes Yes No
191 Raltegravir for HIV-1 infection in adults (15KB) Dec 2010 No Yes No
186 Anti-VEGF prior to vitrectomy for proliferative diabetic retinopathy (26KB) Oct 2010 No Yes No
184 Bexarotene for refractory cutaneous T-cell lymphoma (21KB) Oct 2010 No Yes No
183 Plerixafor for non-Hodgkin’s lymphoma and multiple myeloma (26KB) Oct 2010 No Yes No
177 Atomoxetine for Attention Deficit Hyperactivity Disorder (ADHD) in adults (33 KB) Aug 2010 No Yes No
171 Breast cancer (metastatic) - albumin-bound paclitaxel (16 KB) Aug 2011 No Yes No
170 Bendamustine for relapsed/refractory non-Hodgkin's lymphoma (19 KB) July 2010 No Yes No
169 Dasatinib and nilotinib for chronic myelogenous leaukaemia (23 KB) July 2010 No Yes No
168 Zoledronic acid for skeletal events in advanced breast and prostate cancer (20 KB) July 2010 No Yes No
167 Yttrium radio-embolisation for liver metastases from colorectal carcinoma (18 KB) July 2010 No Yes No
166 Yttrium radio-embolisation for hepatocellular carcinoma (18 KB) July 2010 No Yes No
165 Epirubicin, oxaliplatin and capecitabine triple therapy (EOX) for advanced metastatic gastro-oesophageal cancer (19 KB) July 2010 No Yes No
164 Aprepitant for chemotherapy-induced nausea and vomiting (19 KB) July 2010 No Yes No
163 Alemtuzumab for B-cell chronic lymphocytic leukaemia (16 KB) July 2010 No Yes No
162 Carmustine for recurrent glioblastoma multiforme (19 KB) July 2010 No Yes No
161 Bortezomib for dialysis prevention in untreated myeloma (19 KB) July 2010 No Yes No
160 Methylphenidate and atomoxetine for Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents (32 KB) July 2010 No Yes No
159 Buprenorphine/nalaxone combination therapy for opioid misusers (21 KB) July 2010 No Yes No
151 Zoledronic acid for glucocorticoid-induced osteoporosis (34 KB) Feb 2010 No Yes No
149 Drug therapies for pulmonary hypertension (25 KB) Jan 2010 No Yes No
148 WITHDRAWN - Exenatide for type 2 diabetes mellitus (57 KB) Jan 2010 Yes Yes No
147 Anti-VEGF drugs for neo-vascularisation in conditions other than wet age-related macular degeneration (21 KB) Dec 2009 No Yes No
146 Vitamin D supplementation (high dose) (19 KB) Dec 2009 Yes Yes No
144 Growth hormone for children born small for gestational age (21 KB) Nov 2009 No Yes No
141 Maraviroc and raltegravir for triple class resistance to HIV therapy (20 KB) Nov 2010 No Yes No
139 Rituximab for refractory autoimmune haemolytic anaemia and idiopathic thrombocytopenic purpura (25 KB) June 2009 No Yes No
135 Yttrium radio-embolisation for hepatic metastases from breast cancer (16 KB) May 2009 No Yes No
134 Donepezil, galantamine and rivastigmine for dementia associated with Parkinson's disease and Lewy Bodies (20 KB) May 2009 Yes Yes No
133 Cannabinoids for the management of multiple sclerosis and chronic pain (22 KB) Apr 2009 Yes Yes No
128 WITHDRAWN - Sorafenib for advanced hepatocellular cancer (19 KB) Jan 2009 No Yes No
125 Probiotics (adults and children) (19 KB) Oct 2008 Yes Yes No
124 Eculizumab for paroxysmal nocturnal haemoglobinuria (PHN) (19 KB) Oct 2008 No Yes No
122 Co-careldopa for advanced Parkinson's disease (19 KB) Sept 2008 No Yes No
121 Oxygen therapy (short burst) for breathlessness (30 KB) July 2008 Yes Yes No
120 Drug therapies for restless legs syndrome (30 KB) July 2008 No Yes No
107 Testosterone Patch (Intrinsa®) for Female Hypoactive Sexual Desire Disorder (HSDD) (20 KB) Jan 2008 No Yes No
100 Sodium oxybate for cataplexy and excessive daytime sleepiness in narcolepsy (19 KB) July 2007 No Yes No
99 Grazax® (oral vaccine) for grass pollen hayfever (28 KB) Apr 2007 Yes Yes No
98 Anti-VEGFs for wet age-related macular degeneration (AMD) (21 KB) May 2010 No Yes No
97 Nutritional supplements for age-related macular degeneration (AMD) (17 KB) Mar 2007 Yes Yes No
94 Human Papilloma Virus (HPV) vaccine (21 KB) Sept 2008 Yes No No
92 Natalizumab for multiple sclerosis (94 KB) Feb 2008 No Yes No
91 Varenicline for smoking cessation (20 KB) Oct 2007 Yes Yes No
88 Over the counter (OTC) drugs (17 KB) Dec 2006 Yes Yes No
75 Temozolomide - glioblastoma multiforme (GBM) (111 KB) Mar 2008 No Yes No
72 Bortezomib for relapsed and refractory multiple myeloma (19 KB) Dec 2007 No Yes No
71 Pegvisomant for acromegaly (25 KB) Nov 2005 No Yes No
64 Inosine pranobex for Chronic Fatigue Syndrome/Chronic Epstein Barr virus infection (107 KB) Feb 2005 No Yes No
63 Imatinib for unresectable and/or metastatic gastro-intestinal stromal tumours (GIST) (97 KB) Nov 2004 No Yes No
62 Terbinafine for fungal nail infection (22 KB) Feb 2007 Yes Yes No
55 Angiotensin II receptor antagonists (AIIRAs) for hypertension and diabetic nephropathy (109 KB) June 2004 Yes Yes No
51 Glargine for diabetes (85 KB) Feb 2004 Yes Yes No
50 WITHDRAWN - Activated protein C (drotrecogin alfa) for severe sepsis and multiple organ failure (103KB) Feb 2004 No Yes No
47 WITHDRAWN - Zanamivir, oseltamivir and amantadine for the treatment of influenza (203 KB) Nov 2003 Yes Yes No
46 WITHDRAWN - Oseltamivir and amantadine for the prevention of influenza (203 KB) Nov 2003 Yes Yes No
43 Glucosamine for osteoarthritis (20 KB) Oct 2008 Yes Yes No
42 Gluten free foods for Coeliac's disease (126 KB) Apr 2004 Yes No Yes
41 Treatments for erectile dysfunction (20KB) May 2011 Yes Yes Yes
40 WITHDRAWN - Gamonlenic acid for inflammation and autoimmune diseases (24 KB) Dec 2002 Yes No No
39 WITHDRAWN - Nicotine replacement therapy (NRT) and bupropion (Zyban®) (17 KB) July 2002 Yes Yes No
36 Antipsychotic medication for people with learning disabilities (15 KB) Sept 2004 Yes Yes No
32 WITHDRAWN - Antipsychotic (neuroleptic) medication for behavioural problems in elderly patients with dementia (106 KB) Sept 2004 Yes Yes No
30 Antipsychotics (atypical) for schizophrenia (108 KB) Jan 2003 Yes Yes No
28 WITHDRAWN - Orlistat for obesity (39 KB) Mar 2001 Yes Yes Yes
27 Modafinil (Provigil®) for hypersomnolence in narcolepsy (31 KB) Nov 1998 No Yes No
25 Entacapone (Comtess®) and tolcapone (Tasmar®) for Parkinson's disease (17 KB) Jan 1999 No Yes No
21 Statins for hypercholesterolaemia (18 KB) Sept 2004 Yes Yes No
19 Human growth hormone (somatropin) for adults with growth hormone deficiency (22 KB) Mar 2009 Yes Yes No
14 Beta interferon in multiple sclerosis (156 KB) Nov 2003 No Yes No
12 WITHDRAWN -Proton pump inhibitors (30 KB) Jan 2003 Yes Yes Yes

Surgery, Devices, Screening, Diagnostics And Other Therapies

Ref # Policy Title Last Updated Primary Care Secondary / Specialist Care Referral Guideline Available
219

Dementia - non-pharmacological interventions (Memory Clinics) (20KB)

 Jan 2011 Yes Yes No
210 Cerebral (brain) metastases - neurosurgery (15KB) Dec 2011 No Yes No
209 Hip Impingement (FAI) - surgery (16KB) Aug 2011 No Yes No
205 Bunions (Hallux Valgus) - surgery (25KB) Aug 2011 Yes Yes No
204 Anal skin tags - surgery (22KB) Aug 2011 Yes Yes No
203

Gallstones - surgery (cholecystectomy) for asymptomatic patients(19KB)

 Oct 2011 No Yes No
202 Hip arthropathy (advanced) - hip resurfacing (29KB) May 2011 Yes Yes Yes
199 Aortic Stenosis - TAVI (16KB) May 2011 No Yes No
193 Cochlear implants – sequential - for deaf children (20KB) Dec 2010 No Yes No
190 Dystonia and tremor - deep brain stimulation (17KB) Nov 2010 No Yes No
188

Knee replacement surgery (33KB)Link to Referral Guideline for hip and knee OA: (101KB)

Nov 2010 Yes Yes Yes
187

Hip replacement surgery (30KB) Link to Referral Guideline for hip and knee OA: (101KB)

 Nov 2010 Yes Yes Yes
185 Functional Electrical Stimulation for drop foot (27KB) Oct 2010 No Yes No
182 Arthroscopic lavage for OA knee (25KB) Oct 2010 Yes Yes No
181 Smoking cessation prior to elective surgery (36KB) Oct 2010 Yes Yes No
180 Abdominal aortic aneurysms - fenestrated endovascular stent-grafts (21 KB) Aug 2010 No Yes No
179 Anterior cruciate ligament reconstruction (35KB) Oct 2010 Yes Yes No
176 Hip and knee replacement surgery - routine follow-up (22KB) Dec 2011 Yes Yes No
175 Trigger finger (stenosing tenovaginosis) (34 KB) Oct 2009 Yes Yes Yes
174 Dupuytren's contracture (31 KB) Oct 2009 Yes Yes Yes
173 Circumcision (male) (25 KB) Oct 2009 Yes Yes Yes
172 Carpal tunnel syndrome (24 KB) and Patient Decision Aid (131 KB) Oct 2009 Yes Yes Yes
158 Chronic pain management - inpatient programmes (23 KB) May 2010 No Yes No
157 Non-specific low back pain - spinal surgery (27 KB) May 2010 No Yes No
156 Non-specific low back pain - spinal manipulation (26 KB) May 2010 Yes Yes No
155 Non-specific low back pain - acupuncture (21 KB) May 2010 Yes Yes No
154 Osteoporotic vertebral fractures - percutaneous vertebroplasty (20 KB) May 2010 No Yes No
152 Sickle cell disease - Trans-cranial Doppler ultrasonography to prevent stroke (46 KB) Feb 2010 No Yes No
150 Cerebral metastases - stereotactic radiosurgery (16 KB) Jan 2010 No Yes No
145 Chronic reflux oesophagitis - laparoscopic fundoplication (23 KB) Nov 2009 No Yes No
142 Bone anchored hearing aids (24 KB) Sept 2009 No Yes No
140 Polysomnography (20 KB) July 2009 Yes Yes No
138 Constipation and faecal incontinence - sacral nerve stimulation (22 KB) June 2009 No Yes No
137 Wrist ganglions (24 KB) May 2009 Yes Yes Yes
136 Non-ischaemic cardiomyopathy - implantable cardioverter defibrillator devices (30 KB) May 2009 No Yes No
131 Stroke prevention - carotid endarterectomy and endovascular stent insertion (18 KB) Mar 2009 No Yes No
129 Hyperbaric oxygen therapy (29 KB) Feb 2009 No Yes No
127 Migraine prevention - closure of patent foramen ovale (14 KB) Dec 2008 No Yes No
126 Cataract removal in adults (21 KB) July 2010 Yes Yes No
119 Chronic Fatigue Syndrome / Myalgic Encepthalomyelitis (21 KB) July 2008 Yes Yes No
118 Upper and lower limb neurological dysfunction - electrical stimulation (including Functional Electrical Stimulation) (21 KB) June 2008 Yes Yes No
117 Neuropathic pain - spinal cord stimulation (19 KB) Dec 2008 No Yes No
116 Ischaemic pain - spinal cord stimulation (116 KB) Feb 2009 No Yes No
114 Osteoporosis management - Serum P1NP measurement (97 KB) Mar 2008 No Yes No
113 Hysterectomy (33 KB) and Patient Decision Aid (119 KB) and Heavy Menstrual Bleeding - Care pathway and referral guideline (122KB) Feb 2012 Yes Yes Yes
112 Dilatation and Curettage (D&C) (24 KB) Feb 2008 Yes Yes No
109 Prostate cancer (recurrent) - salvage cryotherapy (16 KB) Jan 2008 No Yes No
108 Prostate cancer (localised) - cryotherapy (16 KB) Jan 2008 No Yes No
106 Unruptured intracranial aneurysms - treatment when discovered incidentally (27 KB) Dec 2007 No Yes No
105 Parkinson's disease (and other indications) - deep brain stimulation (36 KB) Aug 2010 No Yes No
104 Severe spasticity - intrathecal baclofen (58 KB) Oct 2007 No Yes No
103 Prostate cancer - Da Vinci Robotic Prostatectomy (22 KB) Aug 2010 No Yes No
102 Tonsillectomy (19 KB) Dec 2009 Yes Yes Yes
101 Myringotomy / grommets (46 KB) Dec 2009 Yes Yes Yes
96 Orthodontic surgery (29 KB) Feb 2007 Yes Yes No
87 Obesity - bariatric surgery (22 KB)

Supplementary information: 		Mar 2011 Yes Yes Yes
84 Epilepsy (refractory) - vagus nerve stimulation (20 KB) Oct 2006 No Yes No
83 Glioma (high grade) - carmustine implants (98 KB) Mar 2008 No Yes No
82 Dental implants (21 KB) Oct 2006 Yes Yes No
81 Lymphoedema - intensive inpatient therapy (30 KB) July 2006 Yes Yes No
77 Supraventricular tachycardias - elective catheter ablation (21 KB) July 2006 No Yes No
76 Facial hirsutism [see also policy 6] (18 KB) Nov 2005 Yes Yes No
70 Hyperhidrosis - Botulinum toxin A (21 KB) Nov 2005 No Yes No
68 Inguinal hernia (elective surgery) (22 KB) July 2006 Yes Yes No
66 Temporomandibular joint replacement (19 KB) May 2010 No Yes No
61 Heart failure - natriuretic peptide testing to aid diagnosis in Primary Care (15KB) May2011 Yes No No
59 Type 2 diabetes mellitus - blood glucose testing reagents (129 KB) Oct 2004 Yes Yes No
58 Oesophageal stricture - surgical techniques (108 KB) July 2004 No Yes No
57 Multiple sensitivities - multiple chemical sensitivity (MCS) and clinical ecology/ environmental medicine (104 KB) July 2004 Yes Yes No
56 Coronary artery stents (92 KB) June 2004 No Yes No
53 Silicon cosmesis (87 KB) Feb 2004 No Yes No
49 Hyperhidrosis and/or facial blushing - endoscopic thoracic sympathectomy (25 KB) Nov 2005 No Yes No
48 Preimplantation genetic diagnosis (15 KB) July 2010 No Yes No
45 Fibroids - uterine artery embolisation (UAE) (113 KB) Jan 2005 No Yes No
34 Temporomandibular joint dysfunction syndrome - manipulation and intra-articular steroids (20 KB) Mar 2000 No Yes No
23 Tremor - stereotactic radiosurgery (45 KB) Mar 1998 No Yes No
22 Human Papilloma Virus (HPV) screening (34 KB) Feb 1998 Yes Yes No
18 Gender dysphoria (31 KB) Sept 2009 Yes Yes No
13 Prostate cancer screening (22 KB) May 2010 Yes Yes No
11

Assisted conception (55 KB)

Supplementary information:

IVF Referral form (updated Dec 2011) (49 KB)

Oct 2010

 

 

 Yes Yes No
10 Obstructive sleep apnoea/hypopnoea syndrome - CPAP (27 KB) Jul 2008 Yes Yes No
8 Reversal of sterilisation (94 KB) Nov 2003 Yes Yes No
6 Aesthetic surgery (37KB) (Updated Feb 2012 (Policy 6e) Feb 2012 Yes Yes No
5 Port wine stains and skin lesions - laser / pulse dye laser surgery (15 KB) July 2010 Yes Yes No
2 Complementary and alternative therapies (59 KB) Mar 2009 Yes Yes No
1 Varicose veins (24 KB) Nov 2005 Yes Yes No

Local Guidance - Funding And Administration Issues

Ref # Policy Title Last Updated Primary Care Secondary / Specialist Care Referral Guideline Available
221

The Clinical Management of Women with PIP Breast Implants (91KB)

 Feb 2012 Yes Yes National Guidance on the DoH website
200 NICE Medical Technologies and Diagnostic Technologies Guidance - implementation (15KB) Mar 2011 Yes Yes Yes
178 Attention Deficit Hyperactivity Disorder (ADHD) - model of care for adults (26 KB) Aug 2010 No Yes N/A
153 Excess treatment costs for non-commercial trials (25 KB) Mar 2010 Yes Yes N/A
143 Funding of NICE Technology Appraisal Guidance (TAGs) (22 KB) Sept 2009 Yes Yes N/A
132a Haemodialysis away from home (21KB) Dec 2010 Yes Yes National Guidance on the DoH website
130 Reimbursement for living donors - renal transplant (32 KB) Feb 2009 No Yes N/A
115 Implementation of NICE Interventional Procedures Guidance (IPGs) (21 KB) May 2010 No Yes N/A
80 Guidance for considering 'exceptionality' in individual cases (29 KB) Oct 2010 Yes Yes N/A
69 Research trials and NHS funding: the funding of medicines on trial completion for participating patients (24 KB) Feb 2010 Yes Yes N/A
67 Private - NHS funding (56 KB) Sept 2009 Yes Yes N/A
31 Eligibility for non-emergency NHS-funded transport (10 KB) Apr 2004 Yes Yes N/A
16 Treatment only available outside the UK (22 KB) May 1997 Yes Yes N/A

Referral Guidelines can be found on the NHS Oxfordshire intranet. View referral guidelines (N3 connection required).

All policies allow possibilities of exceptions being made - some statements clarify the situations where exceptions are likely to be allowed.

Some statements refer to the policy of Oxfordshire Health Authority. Where this is the case it can be assumed that the policy has been adopted by NHS Oxfordshire, following the dissolution of the Oxfordshire Health Authority. A programme of review of all policies is currently underway.

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