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Procedures of Limited Clinical Value

Further to the email message issued yesterday as copied below, Birmingham LMC has discusses the new “PLCV” policy and the LMC members were sufficiently concerned at many of the proposals to request that I write to all GPs to inform them that they are advised not to co-operate with the policy should their CCG adopt it. Furthermore GPs which have their own concerns with these proposals are strongly urged to bring them directly to the attention of their CCG, which should be requested not to implement the new policy.

The LMC’S position, as stated, is that GPs must have clinical freedom to refer directly for a specialist opinion or assessment whenever they deem it clinically appropriate. The LMC believes that there would be considerable professional and medico-legal risk for GPs were they to act in accordance with many of the proposals in the new policy rather than using their own clinical judgment. Whilst some of the proposals may of course concur with a GP’s clinical judgment and chosen pathway for managing a particular patient, many others will not.

Furthermore GPs should not accept the inevitable increased, un-resourced workload which would follow should this policy be implemented, and finally responsibility for completing any special funding request should rest with secondary care and not with general practice.


I’ve been advised that information on the new PLCV policy (as attached) has been sent to all Birmingham practices. My understanding is that the policy was produced by Solihull CCG but is being adopted across Birmingham. It would appear that , whilst historically, it was the consultant who felt that the procedure was appropriate who had to make the case for special funding , this task is now left to the GP. This is entirely inappropriate. GPs must retain the clinical freedom to refer for a specialist opinion whenever they believe it is clinically required and this must not be micromanaged by commissioners. It is the consultant who decides on the need for a certain procedure , and if the procedure falls within the CCGs’ definition of a PLCV then it must be the consultant who argues the case for special funding. This work must not be dumped on general practice.

I should be most grateful for your views on this matter; I do hope a reversion to the pre-existing policy will be agreed . I’d be happy to discuss this further if required.

Click here to download the document "Procedures of Limited Clinical Value Leaflet".

Click here to download the document "CCG Procedures of Limited Clincal Value Policy - January 2016".

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