Low Priority Treatment Policies Each position statement indicates whether the procedure is routinely funded or restricted by specific criteria. If the procedure is not routinely funded or outside of criteria, a referral to secondary care services should not be made before approval is given by the Low Priority Treatments Panel. For further information please refer to the Individual Funding Requests Policy which is available at http://www.kernowccg.nhs.uk/get-info/individual-funding-requests/ Or contact: Individual Funding Requests Office NHS Kernow Sedgemoor Centre Priory Road St Austell Cornwall PL25 5AS 01726 627 964 NHS Kernow.IFRequests@nhs.net Approved by: Governance and Assurance committee Date Approved: 28 April 2015 Produced by: Exceptional Treatments Manager Review Date: 9 April 2017 1
Abdominoplasty / apronectomy Arm, buttock or thigh lift Artificial urinary sphincters for post prostatectomy Assisted Conception Blepharoplasty (eyelid surgery) or brow lift for hooded eyelids / excess skin folds of the eyes / bulging fat pads Botox injections for hyperhydrosis (excessive sweating) or aging skin on any part of the body or face Breast asymmetry correction Breast augmentation (breast implants) Breast reduction Breast prosthesis (implant) removal and replacement Brow lift Bunions Buttock, arm or thigh lift Caesarian section (elective) for non-clinical reasons See policy for Artificial Urinary Sphincters for Post- Prostatectomy Incontinence See policy for Assisted Conception Not commissioned for cosmetic reasons. See policy for Blepharoplasty See policy for Breast implants removal and replacement See policy for Blepharoplasty See policy for Hallux valgus See policy for Caesarian section (elective) for nonclinical reasons 2
Chalazion (Meibomian cysts) Circumcision Cosmetic or non-clinical treatments Cryopreservation of gametes or embryos Dermabrasion of skin Ear lobe repair Elective single embryo transfer (eset) Face lift Ganglion - removal of (wrist and hand) Gynaecomastia surgery (removal of male excess breast tissue) Hair graft for male pattern baldness Hallux vagus (bunions) surgical procedures Hip - arthroscopy See Guidance for the management of referrals for Meibomian Cysts See policy for Circumcision This applies to all treatment for cosmetic/aesthetic reasons in any specialty, all patients including transgender and patients of all ages, including children. It excludes treatments and reconstruction for cancer. See policy for Cryopreservation of gametes or embryos See policy for elective single embryo transfer (eset) See policy for Wrist (and hand) Ganglia (removal of) Please note: Only those patients with a BMI of 25 or below, and post puberty will be considered. See policy for Hallux valgus See policy for Open or arthroscopic surgery for the treatment of femoro-acetabular impingement 3
Homeopathy treatment referral to secondary care Hyperhidrosis Hysterectomy for noncancerous heavy menstrual bleeding Inverted nipple correction Knee - arthroscopy Laser hair removal Labiaplasty (reshaping of the labia) Laser surgery for myopia (short sight) Laser treatment for post acne scarring Liposuction (removal of excess fat tissue) Mastopexy (breast lift) Meibomian cysts Myringotomy with and without grommet insertion Penile Prosthesis See policy for Hysterectomy for non-cancerous heavy menstrual bleeding See policy for Arthroscopy of the knee joint Exclusions include recurrent pilonidal sinus and post hair bearing flap reconstructions. See Guidance for the management of referrals for Meibomian Cysts See policy for Myringotomy See policy for Penile Prosthesis 4
Pinnaplasty (correction of protruding ears) Reversal of sterilisation (male and female) Rhinoplasty (nose reshaping) Rhinophyma (surgery or shave) Scar revision Skin lesions removal of non-cancerous lumps and bumps surgically or by laser in primary and secondary care (including moles, naevi, cysts, seborrhoeic keratosis, lipomata, skin tags, warts, thread veins, telangiectasia, sebaceous cysts, xanthelasma, verrucas, warts Tattoo removal Thigh, arm or buttock lift Tonsillectomy Varicose veins procedures All applications should include presence or absence of antihelical fold and degree of projection (>2cm). See policy for benign skin lesions (removal of). Exclusions include: - All suspected melanoma and squamous cell cancers should be referred via the suspected cancer two week system - Diagnostic uncertainty eg suspected basal cell carcinoma See policy for Tonsillectomy See policy for Varicose Vein Procedures 5