Agenda item

Adherence to Evidence Based Medicine

To receive the report from Dr Mo Abedi (Enfield CCG Medical Director).


RECEIVED the report of Regina Shakespeare, Project Consultant and Mark Eaton, Director of Recovery, Enfield CCG in respect of the programme ‘Adherence to Evidence Based Medicine’.




Regina Shakespeare introduced the report, highlighting the key points:

?  Evidence reviews were being led by Clinical Leaders at the CCG.

?  Procedures of Limited Clinical Effectiveness (PoLCEs) were procedures where the evidence supported the adoption of thresholds and criteria.

?  Policies were in early stages and there had been some pre-engagement.

?  There would be discussions with the Scrutiny Health Work Stream in respect of formal engagement and consultation.

?  There would be co-ordination with colleagues supporting Sustainability and Transformation Plan (STP) planning.


Dr Jahan Mahmoodi, Medical Director CCG, was invited to make additional comments, including:

?  It had been found that GPs were not adhering strictly to the evidence base.

?  Packs of evidence were publically available on the seven key procedures listed in the paper.

?  Robust discussions were taking place with clinicians.

?  The plan in Enfield was to continue to review the evidence and to roll out the engagement programme.


IN RESPONSE to the report, the following comments were received:


1.    Vivian Giladi (Voluntary Sector) asked about the pre-engagement, and noted there was some public concern regarding the key procedures listed. She asked the CCG to be more active in explaining simply to the public what this means.

2.    Councillor Doug Taylor, Chair, was concerned that rationing of resources would be seen as the driver of the policies, and asked about patient choice. Dr Mahmoodi stressed that choice was paramount in the NHS within a given therapeutic remit. Important aspects which must be taken into account included recovery, surgical aspects, and the impact a condition had on a patient’s life. GPs and patients came to joint decisions about treatments: this evidence base would inform their conversations in a more inclusive way. A decision could be made together with the GP to refer, or an Individual Funding Request (IFR) could be referred to a panel.

3.    In response to Councillor Alev Cazimoglu’s queries about potential differences in implementation of thresholds across boroughs, it was confirmed that dialogue was with all clinicians across all the North Central London (NCL) CCGs and this was about standardisation of the quality of care across the region. The aim was that any clinical decision should be evidence based.

4.    Ray James (Director of Health, Housing and Adult Social Care) reinforced Councillor Cazimoglu’s point, and that the Health and Wellbeing Board could not be comfortable if Enfield residents were not afforded access to treatments that others were. For the policies to progress there would need to be transparent fairness across North Central London which could be explained to the public and ensure consistency.

5.    Tessa Lindfield (Director of Public Health) welcomed the proposals and highlighted that it was not just about money and that patients should not be put through unpleasant procedures that did not work. In response to her queries about views of secondary clinicians, it was confirmed that the best approach was early dialogue with consultants and GPs. Discussions so far had been very robust, with an hour long discussion for example yesterday on IVF.


AGREED to support the approach being taken, noting comments made and that there should be no deterioration in patient outcomes, that there should be no second class offer in Enfield compared to Islington, Camden and Barnet, and that Health and Wellbeing Board wished the consultation to be open and extensive.

Supporting documents: