1. Adherence to Evidence Based Medicine
Bunions
Matt Rogers, Transformation Programme Manager
Enfield Clinical Commissioning Group
MR v01

2. Bunions – Approach
Performed a review across a number of CCGs in order to assess the variation in provision of access between Enfield, North Central London and other CCGs as follows:
North West London CCG
North East Essex CCG
South East London CCG
Cambridgeshire CCG
Berkshire CCG
Others
Collated evidence on eligibility criteria
Data analysis including:
Activity & Spend
Trend Analysis
Benchmarked Enfield CCG data against North East London CCGs, standardised per 1,000 population

3. Activity 2015/16 62 Cost 2015/16 £173,631 Bunions – Activity & Spend
ENFIELD CCG Data
Activity 2015/16 62
Cost 2015/16
£173,631

4. Bunions – Activity & Spend – Trend Analysis

5. Bunions – Benchmarking
Spend Standardised Per 1,000 Population
Enfield CCG
NCL CCGs
BHR CCGs
WELC CCGs
Bunions (Hallux valgus) surgery
£151.3
£105.9
£97.1
£72.8

6. ENFIELD NCL Other CCGs Bunions– Policy/Criteria Comparison
NICE Guidance states:
In hallux valgus (Bunion) the big toe is deviated towards the other toes and a bony protrusion (a bunion) is formed by medial deviation of the first metatarsal phalangeal joint. There may be damage to the skin over the bunion, pain when walking, cosmetic concerns and difficulty with footwear.
2.1.2 Conservative treatment may include footwear modification, and use of insoles or toe spacers. Common surgical treatment options involve different types of first metatarsal osteotomy.
2.2 Outline of the procedure
2.2.1 Surgical correction of hallux valgus using minimal access techniques is carried out with the patient under local or general anaesthesia and with X-ray or endoscopic monitoring. One or more small incisions are made close to the hallux metatarsophalangeal joint. The bunion is removed and the metatarsal is divided surgically. The bone fragments may be stabilised using plates, screws or wires. A dressing or plaster may be used to support the foot in the corrected position until the divided bone heals
ENFIELD
Organisation
Eligibility Criteria Exists
Enfield CCG N
Enfield CCG has not adopted a policy / criteria for elective Bunions surgery
NCL
Other CCGs
Organisation
Eligibility Criteria Exists
BARNET CCG N
HARINGEY CCG
ISLINGTON CCG
CAMDEN CCG
Organisation
Eligibility Criteria Exists
Dorset CCG Y
Bristol CCG
Gloucestershire CCG
Basildon & Brentwood, Southend, Castle Point & Rochford, and Thurrock CCGs