Variations in clinical commissioning of circumcision surgery in England – are there equal standards of care for patients?
BAUS ePoster online library. Clark C. 11/10/20; 304222; P11-10
Mr. Calum Clark
Mr. Calum Clark
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Variations in clinical commissioning of circumcision surgery in England – are there equal standards of care for patients?

Clark C1, Coffey D2, Hudson-Phillips S3, McCauley N4, Desu K5, Gaukaner A5, Vig S5
1Guys & St Thomas' NHS Trust, London, United Kingdom, 2The Royal London, London, United Kingdom, 3St George's Hospital, London, United Kingdom, 4Lister Hospital, Stevenage, United Kingdom, 5Croydon University Hospital, London, United Kingdomg

Introduction:
Circumcision is the most commonly performed surgical procedure globally. In the UK, Circumcision has been classified as 'a procedure of low clinical value' (PLCV) by NHS England allowing individual clinical Commissioning groups (CCGs) to produce their own policies and criteria for funding. This study analyses the variation in CCG indications and policy for circumcision surgery across England using BAUS guidance as the gold standard.
Methods & Materials: Each of the 195 CCGs website was accessed to review their published policy on the medical indications for circumcision funding. A freedom of information (FOI) request was sent where data was unavailable for public view.

Results:
162/195 CCGs supplied data for the study (5/195 CCG's had no documented policy, 26/195 did not respond to the FOI request). 47/162 (29%) CCGs had the same indications (n=7) for circumcision funding as BAUS guidelines (range; 0-10 indications). The most common indications were pathological phimosis and Balanitis/Balanoposthitis (n=162 & 155 respectively). The least common indications were the inability to retract foreskin (n=9) and UTI prevention secondary to long-term catheter (n=6), neither of which are recommended indications by BAUS. 33/162 required conservative measures for at least 3 months before consideration for funding and 13/162 required prior CCG panel approval for funding for all indications.

Conclusions:
BAUS have clear guidance on the current evidence-based indications for circumcision however, this is frequently overlooked by individual CCGs. This has resulted in unequal and inequitable access to surgery dependent on geographic location, creating a postcode lottery for this urological procedure.
Variations in clinical commissioning of circumcision surgery in England – are there equal standards of care for patients?

Clark C1, Coffey D2, Hudson-Phillips S3, McCauley N4, Desu K5, Gaukaner A5, Vig S5
1Guys & St Thomas' NHS Trust, London, United Kingdom, 2The Royal London, London, United Kingdom, 3St George's Hospital, London, United Kingdom, 4Lister Hospital, Stevenage, United Kingdom, 5Croydon University Hospital, London, United Kingdomg

Introduction:
Circumcision is the most commonly performed surgical procedure globally. In the UK, Circumcision has been classified as 'a procedure of low clinical value' (PLCV) by NHS England allowing individual clinical Commissioning groups (CCGs) to produce their own policies and criteria for funding. This study analyses the variation in CCG indications and policy for circumcision surgery across England using BAUS guidance as the gold standard.
Methods & Materials: Each of the 195 CCGs website was accessed to review their published policy on the medical indications for circumcision funding. A freedom of information (FOI) request was sent where data was unavailable for public view.

Results:
162/195 CCGs supplied data for the study (5/195 CCG's had no documented policy, 26/195 did not respond to the FOI request). 47/162 (29%) CCGs had the same indications (n=7) for circumcision funding as BAUS guidelines (range; 0-10 indications). The most common indications were pathological phimosis and Balanitis/Balanoposthitis (n=162 & 155 respectively). The least common indications were the inability to retract foreskin (n=9) and UTI prevention secondary to long-term catheter (n=6), neither of which are recommended indications by BAUS. 33/162 required conservative measures for at least 3 months before consideration for funding and 13/162 required prior CCG panel approval for funding for all indications.

Conclusions:
BAUS have clear guidance on the current evidence-based indications for circumcision however, this is frequently overlooked by individual CCGs. This has resulted in unequal and inequitable access to surgery dependent on geographic location, creating a postcode lottery for this urological procedure.
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