Prior approval for cosmetic treatments

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  • During the summer of 2017, Bristol, North Somerset and South Gloucestershire CCGs consulted on a proposal to a change to the criteria for accessing treatment for a specific list of conditions that are considered by doctors to be ‘cosmetic’ in nature or of low clinical value.

    Following the consultation exercise for prior approval for cosmetic treatments, the combined Governing Body of Bristol, North Somerset and South Gloucestershire CCGs approved the new policy in September 2017 and it was put in place from mid-October.

    As part of our consultation principles, we report back on what you said to us about the proposal and what our response was. A summary of this can be found in the ‘You Said, We Did’ report below.

    NHS Proposals 2017 - Prior approval for cosmetic treatments: You Said, We Did report

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    This report summarises feedback we received during our consultation on prior approval for cosmetic treatments and what we have done as a result.

    About the proposal

    Bristol, North Somerset and South Gloucestershire CCGs are proposing a policy whereby cosmetic treatments which are not for health improvements will require prior approval from the CCG.

    This brings Bristol, North Somerset and South Gloucestershire in line with other CCGs which adhere to a strict policy of not funding cosmetic or aesthetic surgery.

    A review has established that the NHS in this area spends in excess of £1 million a year carrying out these operations. These procedures are mainly cosmetic or aesthetic and therefore of limited clinical value. Examples include breast reduction operations and cosmetic ear pinning.

    Patients will still be able to apply via their GPs if they feel their physical or mental health or function is impaired. The following procedures will be included in this policy:

    • Abdominal loose skin removal 
    • Female breast surgery policy, including: breast asymmetry surgery, breast implant/augmentation surgery and breast reduction
    • Male breast surgery policy 
    • Congenital ear deformity correction surgery including pinnaplasty
    • Cosmetic surgery or treatment
    • Divarication of recti
    • Epididymal cysts
    • Female genitalia surgery policy
    • Ganglia removal
    • Hydrocele in males policy
    • Testicular prosthesis

    NHS proposals July 2017: summary document

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    In July 2017, we identified a number of opportunities to improve services and increase efficiency which are outlined in this summary document.

    Jargon Buster

    Criteria Based Access [CBA] – Where a CCG has published a policy setting out eligibility criteria. If clinicians are content that the patient meets the criteria, they may proceed to treat without seeking funding approval.

    Prior Approval [PA] – Where a CCG has published a policy setting out eligibility criteria. Clinicians, where they feel patients meet the criteria, must seek funding approval from the commissioners prior to treating.

    Individual Fund Request [IFR] – Where a CCG has published a policy stating that certain treatments are not routinely funded. Treatment will only be funded via agreement from commissioners in exceptional circumstances

    Clinical pathway – A systematic way of treating and managing diseases in the NHS. A clinical pathway outlines the way a patient should be cared for through the NHS system from first presentation, followed by testing and diagnosis and through to completion of treatment.