Procedures of Limited Clinical Effectiveness: Review and Update

In north central London (NCL) we are committed to improving patient outcomes and the quality of care for our residents. This means that we must periodically review what we do to make sure that the care we provide is up to date. This happens across the country, not only because there is significant variation in why or when things are done, but also because we must safeguard tax-payers money, spend wisely and make sure we are able to provide the right care now and in future. 

Our partnership is helping us work better together, as greater consistency achieved through collaboration is one of the keys to our success.

 Our aim is to have a consistent, evidence-based approach to delivering all treatments or procedures. As part of this process we collate and update a list of procedures known as PoLCE (Procedures of Limited Clinical Effectiveness).

 We do this because as research is carried out and medicine advances, some interventions can be found to be inappropriate in certain circumstances. Sometimes, a safer, less invasive alternative becomes available, in which case it is important that it is recognised and recommended as best practice. In this situation, ineffective or outdated treatments should be stopped. In other circumstances, some interventions can result in unintended complications or harm and therefore, are best undertaken only in carefully considered circumstances. 

Most importantly, is for every resident to be able to access the treatment they need and for this to be done on the basis of a personalised conversation with the doctor caring for them and for both parties to have clear information to help the discussion and make the right choice. 

The NCL PoLCE policy has been in place since 2011. This policy has been reviewed and the latest update came into effect in January 2019.   

The aim is to ensure that all residents, living in the boroughs of Barnet, Camden, Enfield, Haringey and Islington, are treated in an equal manner when it comes to receiving evidence-based care. 

Any change to treatment will only apply to a very specific set of procedures outlined in NCL PoLCE policy; the majority of referrals undertaken for residents in our area will not be affected. This policy does not affect any referrals for suspected cancers or any form of urgent or emergency treatment. 

There will be regular reviews of the NCL PoLCE Policy as new clinical evidence and guidance emerges and interventions are replaced by those that are less invasive or more effective.  

A resident who has been referred before the policy was updated and is due to receive treatment for a procedure that is included in the updated policy will have the treatment completed. 

Residents who are currently receiving a treatment cycle listed in the updated NCL PoLCE Policy can complete their care as scheduled. However, if further treatment cycles are to be considered and where there is a recognised update to the clinical evidence, the responsible doctor will take this into account, as is standard good medical practice. There will be circumstances where, counter to policy statements, there is deemed to be evidence of benefit for a given patient, in which case the responsible doctor is able to bring this information for consideration by a formally appointed group of clinical specialists and peers, via an Individual Funding Request (IFR). 

All new referrals received after January 2019, for procedures or treatments covered by the updated policy will be subject to consideration of the policy statements. 

We are working to ensure the application of this policy is as user-friendly and streamlined as possible so it is used by everyone. We are preparing a number of information leaflets to explain clearly the specific details about pathways and processes to both our staff and residents. We recognise the importance of doctors and patients understanding the information needed to support them in the process of joint decision making about the care they receive. This will include information on how to give feedback or ask questions. 

We are committed to making sure that we continue to be able to offer the best care for local people. We understand how important it is for residents to feel they are treated equally, no matter where they live in our local area. 

The policy will be reviewed on a regular basis as we update different areas in line with the most up to date and validated evidence base. We are committed to prioritise areas for review where the need arises and have a clear and transparent process in place to make sure we are clear about how to engage, consultant on and agree any future changes.

If you have any questions please email