title: The impact of commissioning for rhinosinusitis in England.
abstract: OBJECTIVE
  To assess the compliance of clinical commissioning groups (CCGs) in England with the ENT-UK rhinosinusitis commissioning guide produced in collaboration with the Royal College of Surgeons England and the National Institute of Clinical Excellence. We also aimed to assess the ease of accessibility of data from CCGs.
  
  
  METHODS
  Audit of compliance of English CCGs with the ENT-UK rhinosinusitis commissioning guide.
  
  
  METHODS
  CCGs in England
  
  
  METHODS
  A total of 58 of the 221 CCGs in England were included and chosen because they were the first CCGs authorised by NHS England, or alternately, the CCGs forecasted to have a deficit in their first year of operation. Their websites were reviewed; when information was not easily accessible, a freedom of information request was submitted to the relevant CCG.
  
  
  METHODS
  Compliance with commissioning guidelines for rhinosinusitis.
  
  
  RESULTS
  Thirteen percent of CCGs had restrictive referral criteria in place, largely unrelated to published evidence-based guidance. The routine use of multiple courses of oral steroids, prescription of antibiotics, CT scanning within primary care, and delaying referral for a year, prior to referral to a specialist were recommended against published advice.
  
  
  CONCLUSIONS
  Restricting access to surgery may contribute to poorer outcomes and a decrease in the patient's quality of life. This is against the NHS constitution and is open to legal challenge. We encourage all ENT surgeons to review policies of their local CCG and engage with commissioners to ensure that their patients have evidence-based care.
authors: Lancashire Teaching Hospitals NHS Trust, Preston, UK.
authors: A
authors: A
authors: Soni-Jaiswal
authors: James Paget University Hospital, Great Yarmouth, UK.|Norwich Medical School, University of East Anglia, Norwich, UK.
authors: C
authors: C
authors: Philpott
authors: Guys and St Thomas' Hospital, London, UK.|King's College, London, UK.
authors: C
authors: C
authors: Hopkins
mesh_terms: D000328:Adult; D026683:Advisory Committees / Q000458:organization & administration*; D054976:Clinical Governance / Q000458:organization & administration*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*; D011788:Quality of Life; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D013222:State Medicine / Q000458:organization & administration*