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Ganglia Excision

As part of the ongoing review of clinical policies for all the NHS Clinical Commissioning Groups (CCGs) in Lancashire and South Cumbria and following the statutory guidance issued by NHS England around 17 procedures included in their Evidence Based Interventions (EBI) guidance, we are now seeking your feedback on one additional clinical policy. This is a new clinical policy for 6 of our CCGs.

The patient access criteria for this policy has already been through a public consultation and been made mandatory guidance to Clinical Commissioning Groups.  We are not therefore, seeking feedback on the criteria as this cannot be changed. The engagement being undertaken is to inform you about the new policy and to give you the opportunity to comment on any adverse impact you feel this will have and what the CCG should do to minimise this.

The clinical policy open for patient and public feedback is the policy for ganglia excision.

The policy can be found below. You are invited to read the clinical policy before giving your feedback. You can click on the link next to the policy in order to complete a short survey and give your views.

Chorley South Ribble and Greater Preston CCGs already have a ganglia excision policy, but they have chosen to adopt the NHS England EBI criteria to align the policy with the other CCGs.  The policies are not widely different but the EBI criteria has a broader scope and more detail.  Residents of these CCG areas are also encouraged to provide their feedback. You can read the level of change document for these CCGs here. 

Your comments will be fed back to the CCGs as part of the implementation process.

Your feedback for this policy should be submitted by Wednesday 13 February 2019.

Policy for Ganglia Excision

Once you have read the new policy you can provide feedback through this online survey


If you have any further questions about this policy or the process being undertaken you can email or ring 01772 214244.

If you require any of these documents in an alternative format such as Braille, larger print, audio, British Sign Language or in a language other than English please contact the Customer Care Team in one of the following ways:

Further opportunities will be made available for your involvement and feedback on other clinical policies as and when they are developed and available for discussion.

Frequently asked questions

These frequently asked questions are supplementary to the FAQ’s already identified as part of the clinical policy review process.

What are ganglia?

Ganglia are cyst-like swellings of fluid which form around the wrists or in the hand. In most cases those on the wrists only cause mild symptoms and many of these go within a year without treatment. Some, however, can cause pain (by pressing on the nerves) and may reduce hand function.

What treatments are available?

Most wrist ganglia get better on their own and do not require treatment. Many people live comfortably with ganglia and they often resolve spontaneously over time. Where the ganglia are painful or affect hand function then they would normally be treated by aspiration (punctured with a hypodermic needle. Excision (or surgery)

Why is the public engagement taking place now, just after the Christmas period?

NHS England has recently issued statutory guidance to NHS Clinical Commissioning Groups which requires them to have policies in place covering the treatments identified below, by April 2019. In order to meet this requirement and to ensure the policies are fit for purpose, public engagement needs to be undertaken in good time to accord with the official decision-making process.

NHS England has already undertaken a patient and public consultation on the criteria identified in these policies and there is not an opportunity, therefore, to change them further. Although NHS England is making the criteria for these treatments’ mandatory (as a minimum – CCGs can elect to go further), Clinical Commissioning Groups are still required to inform and involve patients and members of the public. A suitable period of public engagement needs to be undertaken, therefore, but it must allow CCGs to meet the obligations laid down by NHS England.

Why are NHS England making these policies mandatory? Is this about saving money?

Both NHS England and the NHS Clinical Commissioning Groups are of the view that one of the main objectives of policies of this nature is to reduce avoidable harm to patients. With surgical procedures, there is always a risk of complications. In addition, professional staff time is wasted if unnecessary procedures are undertaken.

The staff time and resources saved by undertaking this procedure appropriately allows that time and resources to be used elsewhere within the local NHS. Any savings generated in this respect, therefore, are ploughed back into the service where it is needed. Inappropriate care is also poor value for money for the taxpayers who make the NHS possible.

Having consistent treatments decisions based on the latest evidence also helps health professionals keep up to date without removing their clinical discretion which forms part of their professional duties. At a time when demand far outweighs capacity, these decisions reflect the national and local priority of using resources effectively.

What will this mean to patients?

The policies being introduced guide the decisions made by CCGs about the procedures that will be made available to patients for these conditions. This is in both what the CCG will commission and in what Providers of services will be asked and paid to deliver. This has a direct impact upon which of these procedures patients and the public can expect to receive from their local NHS services.

Although some patients may no longer be eligible for these procedures, this is because the nonsurgical alternatives are safer, effective means of treating these conditions. Where a procedure is no longer routinely available on the NHS (as is the case with one of the policies/procedures below), patients can still have access to them if their GP/consultant believes they are an exception and will benefit from receiving it. This is called submitting an Individual Funding Request (IFR) and this option is always open to clinicians.

An individual funding request can be made by your clinician (GP or other health professional) if they believe that a particular treatment or service that is not routinely offered by the NHS is the best treatment for you, given your individual clinical circumstances.

When will these policies be adopted by the CCGs?

As part of the drive for introducing these policies at this time is the mandatory guidance from NHS England, the policies need to be in place for 1 April 2019. Public engagement will take place over a 3-week period following which the responses provided will be assessed. However, as this is mandatory, no change will be made the policy criteria. The policy will then need to be considered by the Commissioning Policy Development and Implementation Working Group, which is overseeing the policy review process, before final consideration by the Joint Committee of Clinical Commissioning Groups, which ratifies polices on behalf of all 8 CCGs.