FOI 2025/1333

I am writing to request the following information under the Freedom of Information Act 2000, in relation to the NICE guideline NG73 on the diagnosis and management of endometriosis (published September 2017).

I am also writing to request the following information under the Freedom of Information Act 2000, in relation to the NICE guideline NG157: “Joint Replacement (Primary): Hip, Knee and Shoulder” (February 2020). The guidance provides evidence-based recommendations for best practice in the delivery of joint replacement surgery and pre/post-operative care.

Diagnosis and management of endometriosis

1.Referral Pathways and Initial Management

NICE NG73 recommends that primary care clinicians should consider endometriosis in women presenting with certain symptoms and outlines when referral should be made to a gynaecology service (Recommendations 1.1.1–1.1.3).

1a. Does NHS Greater Manchester ICB provide specific guidance or care pathways to primary care providers regarding when to refer patients for suspected endometriosis?

1b. Do you monitor adherence to these referral pathways by primary care providers across your footprint? If so, please share any evaluation reports from the past 2 years.

2. Access to Specialist Endometriosis Services

NG73 recommends referral to a specialist endometriosis service in cases of deep endometriosis or where initial treatment has been unsuccessful (Recommendation 1.4.1).

2a. Which specialist endometriosis centres or services are commissioned by NHS Greater Manchester ICB for patients requiring advanced care?

2b. What is the current average and longest recorded waiting time for a referral from primary care to a specialist endometriosis service within NHS Greater Manchester ICB?

3. Multidisciplinary Care and Support

NICE recommends that specialist endometriosis services include a multidisciplinary team (MDT) of gynaecologists, surgeons, pain management specialists, fertility experts, and others as appropriate (Recommendation 1.4.2).

3a. Do the specialist services commissioned by NHS Greater Manchester ICB include access to a full MDT as specified in the NICE guidance?

3b. How many patients have been referred to an MDT for endometriosis-related care in the past 12 months?

4.  Surgical Expertise

The guideline states that excision or ablation of endometriotic lesions should be performed only by practitioners with appropriate training and experience (Recommendation 1.5.3).

4a. Does NHS Greater Manchester ICB maintain oversight or assurance mechanisms to ensure endometriosis surgery is carried out by appropriately qualified professionals?

4b. How many patients underwent laparoscopic surgery for endometriosis in the last 12 months within NHS Greater Manchester ICB area?

5. Awareness and Education

NICE emphasises the importance of raising awareness of endometriosis among healthcare professionals (Recommendation 1.1.4).

5a. Has NHS Greater Manchester ICB conducted or funded any training or awareness campaigns on endometriosis for primary or secondary care professionals since 2020? If so, please provide details.

6. Data Collection and Audit

6a. Does NHS Greater Manchester ICB collect any data or conduct audits specifically relating to endometriosis diagnosis, treatment, or outcomes?

6b. If so, please provide the most recent audit results or performance data available.

Joint Replacement (Primary): Hip, Knee and Shoulder

7. Referral Pathways and Thresholds for Surgery

Related to Recommendations 1.1.1–1.1.5

7a. Does NHS Greater Manchester ICB use any formal criteria or thresholds (e.g. Oxford Hip Score) to determine eligibility for referral to secondary care or surgery for primary hip replacement?

7b. Do you commission or support any “triage” services (e.g. MSK hubs, community physiotherapy) that must be accessed prior to secondary care referral?

8. Shared Decision-Making and Information Provision

Related to Recommendations 1.2.1–1.2.3

8a. Are patients referred for hip replacement routinely provided with NICE-compliant decision aids or written information on surgical options, benefits, risks and recovery timelines?

8b. Is shared decision-making formally monitored or audited by NHS Greater Manchester ICB or provider trusts?

9. Choice of Implant and Surgical Technique

Related to Recommendations 1.3.1–1.3.7

9a. Does NHS Greater Manchester ICB have any policies or contracts in place that influence which hip implants (e.g. cemented vs. uncemented) can be used by providers?

9b. Do you require providers to follow NICE’s recommendation to use implants that meet ODEP 10A* or equivalent standards for survivorship and performance?

9c. Is data on implant selection and revision rates tracked across your providers?

10. Enhanced Recovery and Length of Stay

Related to Recommendations 1.4.1–1.4.4

10a. Are providers within NHS Greater Manchester ICB expected to follow an Enhanced Recovery After Surgery (ERAS) pathway for hip replacements?

10b. What is the average and maximum length of stay for elective primary hip replacement surgeries in your area?

11. Post-Operative Rehabilitation and Follow-Up

Related to Recommendations 1.5.1–1.5.3

11a. Are all patients offered post-operative rehabilitation (e.g. physiotherapy) following hip replacement?

11b. Is rehabilitation routinely delivered in hospital, the community, or both?

11c. What follow-up protocols are in place (e.g. physiotherapy review, outpatient check-ups), and at what intervals post-surgery?

12. Data Collection and Outcomes

12a. Does NHS Greater Manchester ICB collect or review data on patient outcomes following hip replacement (e.g. PROMs, complication rates, revision surgery rates)?

12b. If so, please provide the most recent audit or summary outcome data available for hip replacement across providers in your area.

Diagnosis and management of endometriosis

1a. The following link is to specific pathways produced by Manchester Foundation Trust for GPs

Pathway Guides – Saint Mary’s Hospital

**PDF documents were sent to the requester with this response, however we are unable to upload these onto our disclosure log.  If you require a copy of the full response, together with all of the attachments, please contact NHS GM’s FOI team – nhsgm.foi@nhs.net.**

1b. No

2a. Commissioned centres to deliver advanced Care:

Bolton NHS Foundation Trust

Northern Care Alliance NHS Foundation Trust

Manchester University NHS Foundations Trust

Stockport Foundation NHS Foundation Trust

Tameside and Glossop Integrated Care NHS Foundation Trust

Wrightington Wigan and Leigh NHS Foundation Trust

In relation to specialised, the Commissioned centres to deliver Complex Endometriosis as set out The Manual of Specialised Services are:

• Northern Care Alliance NHS Foundation Trust – Gynaecology – Endometriosis :: Northern Care Alliance
• Manchester University NHS Foundation Trust – Endometriosis – Saint Mary’s Hospital

2b. NHS Greater Manchester (NHS GM) does not hold the information requested; it will, therefore, be necessary for you to contact the Provider Trusts commissioned in Greater Manchester for the information you seek.  To assist you, please find below links to their websites with information about how to make a Freedom of Information request.

Bolton NHS Foundation Trust – Freedom of information – Bolton NHS FT (boltonft.nhs.uk)

Northern Care Alliance NHS Foundation Trust – Freedom of Information Requests :: Northern Care Alliance

Manchester University NHS Foundation Trust – Freedom of Information – Manchester University NHS Foundation Trust (mft.nhs.uk)

Stockport NHS Foundation Trust – Freedom of Information – Stockport NHS Foundation Trust

Tameside and Glossop Integrated Care NHS Foundation Trust – Freedom of Information Requests :: Tameside and Glossop Integrated Care (tamesideandglossopicft.nhs.uk)

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust – WWL Teaching Hospitals NHS Foundation Trust | FOI Disclosure Log

3a. All accredited and commissioned centres hold MDT’s

3b. Please refer to the response to question 2b.

4a. Professional standards in relation to surgery are overseen in line with GMC and professional standards regulations. For surgeons, this is via Responsible Officers.

In relation to Specialised Services: all commissioned providers are required to comply with the national service specifications that set out the clinical competences required to deliver the treatment and care of women with severe endometriosis. The quality of these services is measured through Specialised Services Quality Dashboard (SSQD) reporting arrangements. Where issues are identified via the SSQD data, providers are required via the contract to provide action plans to address any issues.

4b. Specialised Commissioning North West who commissioning services for NHS Greater Manchester amongst other NHS organisations has provided the information below.

Activity has been identified using the following criteria:

– primary diagnosis of endometriosis (N80) AND

– specified laparoscopic procedure in any position (Y751, Y752 or Y755)

The data was extracted for patients of NHS Greater Manchester ICB at any provider and all patients seen at a GM provider.

955 procedures were carried out on GM registered patients in 2024/25.

Of the 955 spells for registered GM patients 525 were Specialised Complex Endometriosis leaving the remainder 430 Non-specialised procedures.

5a. Yes, NHS GM has shared a set of resources that have been created by NHSE NW Regional team with all GM GP Practices on endometriosis.

6a. No

6b. N/A

Joint Replacement (Primary): Hip, Knee and Shoulder

7a. The ICB was formed when the CCG were abolished, this brought together 10 localities who have all had various arrangements in place which include criteria and/or thresholds to determine eligibility for referral into secondary care. Currently there is a MSK review taking place which is reviewing all arrangements across GM to ensure best practice/referral thresholds are consistent.

7b. There is various iteration of Tier two triage services across GM, once again they are not necessarily operating the same and the MSK review is aiming to streamline this.

8a. All current providers across GM adhere to NICE guidelines and promote best practice, however this will be revisited as part of there GM review.

8b. Not currently.

9a. Not currently, this is at the discretion of the consultant.

9b. All providers follow NICE guidance and would expect them to meet the requirements set out in the guidance, this will also be followed up as part of the MSK review.

9c. Yes, providers collate this information.

10a. Each Trust has its own ERAS pathways. If you need to find out who does what then the requestor would need to contact each trust.

NHS Greater Manchester (NHS GM) does not hold the information requested; it will be necessary for you to contact the Provider Trusts commissioned in Greater Manchester for the information you seek.  To assist you, please find below links to their websites with information about how to make a Freedom of Information request.

Bolton NHS Foundation Trust – Freedom of information – Bolton NHS FT (boltonft.nhs.uk)

Northern Care Alliance NHS Foundation Trust – Freedom of Information Requests :: Northern Care Alliance

Manchester University NHS Foundation Trust – Freedom of Information – Manchester University NHS Foundation Trust (mft.nhs.uk)

Stockport NHS Foundation Trust – Freedom of Information – Stockport NHS Foundation Trust

Tameside and Glossop Integrated Care NHS Foundation Trust – Freedom of Information Requests :: Tameside and Glossop Integrated Care (tamesideandglossopicft.nhs.uk)

Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust – WWL Teaching Hospitals NHS Foundation Trust | FOI Disclosure Log

10b. As above, NHS Greater Manchester (NHS GM) does not hold the information requested; it will be necessary for you to contact the Provider Trusts commissioned in Greater Manchester for the information you seek.  To assist you, please find above links to their websites with information about how to make a Freedom of Information request.

11a. Yes

11b. Both

11c. These will be different provider to provider and would need to be checked via contacting them.

12a. The ICB does not directly collate/review this information.

12b. N/A