Exceptional referral protocols and procedures of limited clinical value

The Exceptional Referral Protocol contains a series of procedures which, as they are not treating an underlying disease process, are not routinely offered by NHS Scotland and can only be provided on an exceptional case basis in line with current guidance.

There is a current refresh of the ERP and a new, updated list is due to be disseminated in Spring 2025. This refresh is focussing on the criteria that will be used to ensure appropriate access. ERP procedures are also ‘PLCV’; Procedure of Limited Clinical Value and will also appear in the Scottish PLCV list when it is finalised and disseminated.

It is anticipated a Scottish list of PLCV will be shared with primary and secondary care clinicians in 2025. Clear referral criteria will be issued in order to provide clinicians with guidance on how to ensure only the small number of people likely to benefit from PLCV procedures (including ERP procedures) can access them.

Criteria to access

We need to ensure that procedures on the ERP are offered fairly and consistently to the small number of people likely to benefit. For the procedures indicated, all referral criteria set out in the exceptional referral protocol must be met before a decision is taken to refer. Referrals which do not meet the specified criteria will not be accepted. If, after vetting, a referral is found not to meet criteria, the referrer will be contacted.

The process will have an appeals process.

If a referring clinician believes a patient is exceptional to the criteria, they will be able to make an appeal to the panel to consider the exceptionality of that individual patient.

The referrer would then have a discussion with the patient to explain the situation. If the referrer then prepares evidence to submit an appeal to the panel this will be considered. The panel may accept the referral at this stage. If the panel rejects the second referral, recommendation will be made to the referrer indicating what would need to change for the ERP criteria to be met.

Resources and links

ERP

CMO(2019)05 - Exceptional Referral Protocol (previously known as the Adult Exceptional Aesthetic Referral Protocol) – refresh April 2019