Aesthetic Policy

This policy applies to all service providers in secondary care and community care that carry out procedures to improve aesthetic appearance

Unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment, prior approval must be sought from the ICB before carrying out any cosmetic procedure (unless it is following trauma, burns, destructive surgery, cancer treatment or congenital malformation), even if the policy indicates that the procedure will normally be funded

Applications for prior approval under this policy should clearly state how the patient meets all the relevant policy criteria

General practitioners should note the provisions of this policy before making a referral to secondary care for a cosmetic procedure

Patients who do not meet the eligibility criteria set out in this policy should not be referred

However, on occasions general practitioners may not be best placed to decide whether or not the policy criteria apply in a particular case and thus may refer to secondary care for an opinion only. In cases of doubt, prior approval should be obtained from the ICB before referral

Although the policy does not apply to treatments that can be prescribed in primary care, or minor surgical procedures that can be carried out entirely within a general practice, GPs may wish to base their decision to treat on the principles and criteria contained within this policy

Patients who do not meet the eligibility criteria set out in this policy will not be offered NHS funding

However, if a clinician (General Practitioner or Consultant) and/or a patient believes that the individual clinical circumstances of their case makes them an exception to the policy, and merits funding on an exceptional grounds, the clinician will need to make an application in accordance with the ICB’s policy for Individual Funding Requests. As such, applications will need to demonstrate that there are unlikely to be other ‘similar patients’ in the population for which the ICB is responsible. (i.e. demonstrate that the patient is significantly different to the general population of patients with the condition in question, and/or is likely to gain significantly more benefit from the intervention than might be expected for the average patient with the same clinical condition at the same clinical stage)

It should be noted that the vast majority of applications for individual case funding for cosmetic procedures suggest that there are various psychological disorders and psychosocial factors associated with the physical problem (e.g. depression, anxiety, feelings of revulsion regarding the physical problem, social withdrawal, problems with sexual relationships and perceptions of teasing/bullying/ostracising by others because of the physical problem)

The co-existence of these factors cannot, therefore, in itself be considered as ‘exceptional’ in these casesObtaining a psychiatric opinion that the patient’s cosmetic problem is contributing to their psychological state does not necessarily indicate that the patient is exceptional and will not guarantee that individual case funding will be agreed. Therefore, psychiatric referral should not be made solely to support an application for individual case funding

Also note that an approval for funding in each case must be sought from the ICB before carrying out the treatment. (This may be obtained before referral for the treatment if appropriate.)

The responsibility for presenting the information relevant to eligibility criteria rests with the clinician

The ICB as commissioner is ultimately responsible for assessing whether or not the eligibility criteria are in keeping with the content and the principles of the policy

Aesthetic procedures for patients who are deemed to be within the normal morphological range will be considered purely cosmetic and therefore NOT funded on the NHS. However, funding may be appropriate to alleviate or improve a physical deformity that most people would recognise as being severely abnormal

Referrals for the revision of treatments originally performed outside the NHS will NOT normally be supported and patients should be referred back to the practitioner who carried out the original procedure. However, in cases where there are significant complications following an aesthetic procedure (for example, infection), or circumstances that require the transfer of a patient to the NHS for appropriate management, the patient will be entitled to routine NHS treatment to treat that complication; but this may not be equivalent to revision of the original procedure. (An example is that complications due to removal of breast implants may be treated by removal of the implants, but the implants may not be replaced.)

Patients previously treated within the NHS should be considered for revision surgery based on clinical need and priority. NHS Coventry and Warwickshire Integrated Care Board

Please see the table below for conditions covered by the Aesthetic Commissioning Policy

Attached are links to relevant GP Gateway pages

 

Treatment	Prior Approval Reference	Gateway Page Reference               (Follow link)
Female breast reduction (reduction mammoplasty)	AES/PA/001	GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Correction of breast asymmetry	AES/PA/002	GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Male breast reduction for gynaecomastia	AES/PA/003	GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Breast enlargement (Augmentation mammoplasty)		GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Revision of breast augmentation	AES/PA/004	GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Breast surgery following cancer treatment relating to an unaffected breast	N/A
Mastopexy	N/A	GP Gateway Breast Enlargement Reduction Revision & Gynaecomastia
Face lifts (Rhytidectomy)	N/A	GP Gateway Face Lifts & Brow Lifts
Surgery on the upper eyelid (Upper lid blepharoplasty) and brow lifts	AES/PA/005	GP Gateway Blepharoplasty
Surgery on the lower eyelid (Lower lid blepharoplasty)	AES/PA/006	GP Gateway Blepharoplasty
Correction of prominent ears (Pinnaplasty or otoplasty)		GP Gateway Pinnaplasty
Abdominoplasty	AES/PA/007	GP Gateway Abdominoplasty
Body contouring	N/A	Not funded
Benign skin lesions including sebaceous cysts	N/A	GP Gateway Benign skin lesions
Laser treatment of skin conditions	AES/PA/008	GP Gateway Laser treatments
Tattoo removal	N/A	GP Gateway Tattoo Removal
Surgical treatment of pigeon chest/chest wall deformity	N/A	GP Gateway Chest Wall Deformity (Pectus carinatum / Pectus excavatum)
Non acute split ear lobe repair / refashioning	N/A	Not funded