FOI 2026/1810

I am writing to request information under the Freedom of Information Act 2000 regarding the ICB’s regional oversight of elective urology productivity, with a specific focus on automated stapler-assisted circumcision (e.g., ZSR/CircCurer).

My recent audit of regional surgical productivity has identified that several member trusts report the absence of internal surgical productivity evaluations for this specific innovation. Consequently, these trusts continue to route routine circumcisions through high-cost, 45–60-minute General Anaesthetic main theatre pathways, despite the availability of 10-minute automated outpatient alternatives. This inefficient use of resources directly contributes to unnecessarily long waiting lists for urological procedures, forcing patients to wait months for routine interventions that could be resolved in minutes in an outpatient or community setting.

To understand the ICB’s oversight of this elective recovery bottleneck and its impact on the region’s long waiting lists, please provide the following:

1) Regional Benchmarking for Circumcision (N30.3): Does the ICB hold any regional benchmarking or comparative productivity data specifically regarding adult circumcision? Specifically, do you hold data comparing traditional hand-sutured theatre throughput against automated stapler-assisted (ZSR/CircCurer) throughput within the region?

2) Productivity Support for Stapler Adoption: Has the ICB provided any regional support, guidance, or funding initiatives to assist member trusts in evaluating or adopting stapler-assisted circumcision to liberate main theatre capacity and reduce waiting lists?

3) Strategic Oversight of Pathway Modernization: Please provide copies of any briefing notes, meeting minutes, or internal strategy documents from the last 12 months concerning the regional directive to transition routine circumcisions from Main Operating Theatre/General Anaesthetic settings to Outpatient/Local Anaesthetic settings.

4) Community-Based Service Delivery: Has the ICB formally considered or piloted the transition of routine circumcisions from secondary care into community or primary care settings? Please provide details on any assessments regarding the viability of these procedures being performed by GPs or doctors, supported by Advanced Nurse Practitioners (ANPs), to alleviate pressure on main theatre lists.

To avoid the application of Section 12 (Cost Limit) exemptions, please note that this request is focused on high-level strategic documents, policy directives, and regional benchmarking reports regarding the ZSR/CircCurer stapler-assisted pathway and does not require a review of individual patient-level data.

1)  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

2)  Not in this specific area however the requestor may wish to approach the providers above direct to understand any productivity support they may have received / undertaken specific to this procedure.

3)  There has not been a specific focus on the transition to routine circumcisions from main operating theatre / general anaesthetic clinics to outpatient / local anaesthetic settings therefore in the last 12 months and so therefore no documentation is not available.

4) NHS GM currently commissions community-based delivery of routine circumcisions from a range of providers in a community setting. Further information can be found on the NHS GM contract database which can be found at Publication scheme | Greater Manchester Integrated Care Partnership