Haemorrhoids in adults

This is a summary of the Northern, Eastern and Western CCG and South Devon & Torbay CCG commissioning policy for the referral and specialist management of haemorrhoids in adults

The referral and specialist management of haemorrhoids in adults commissioning policy

Accompanying clinical policy patient support information for the haemorrhoids policy

Referral

Referral Criteria

Referral for specialist assessment and treatment of haemorrhoids is not routinely commissioned in Devon.

Referral will only be funded if:

The haemorrhoids are prolapsed and incarcerated, and cannot be reduced (Fourth degree haemorrhoids)

Or

The haemorrhoids are recurrent and associated with persistent bleeding

And

There is failure of documented conservative management techniques after at least three months.

Conservative management techniques include:
  • Dietary and lifestyle advice (increase fluid and insoluble fibre intake, discourage straining)
  • Bulk forming laxative (or osmotic laxative or stool softener)
  • Non-opioid analgesia and/or topical haemorrhoid preparations for symptomatic relief
Non-surgical treatment

Non-surgical measures (rubber band ligation, injection sclerotherapy or infra-red coagulation) will only be commissioned in the following circumstances:

Recurrent haemorrhoids

And

Persistent bleeding

And

Failure of documented conservative management techniques after at least three months.

Surgical treatment

Surgical treatment (haemorrhoidectomy, stapled haemorrhoidopexy or haemorrhoidal artery ligation) will only be commissioned in the following circumstances:

Fourth-degree haemorrhoids

Or

Third-degree haemorrhoids associated with persistent bleeding that have not responded to non-surgical treatment in line with the above policy statement, or which are too large for non-surgical measures

Or

Second-degree haemorrhoids associated with persistent bleeding that have not responded to non-surgical treatment in line with the above policy statement

The removal of anal skin tags is not routinely commissioned in Devon.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-ccg.ifr-newsdt@nhs.net

Alternatively, please send to: The Panel administrator at Bridge House, Collett Way, Newton Abbot, TQ12 4PH

Referral Forms

Haemorrhoids in Adults Referral Proforma Microtest

Haemorrhoids in Adults Referral Proforma No merge fields

Haemorrrhoids in Adults Referral Proforma Systmone

Supporting Information

Patient Information

Accompanying clinical policy patient support information for the haemorrhoids policy

Individual Funding Request (IFR) Patient information leaflet

Pathway Group

Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group

Date of publication: 1 December 2015

 

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