Treatment policies

A

Not routinely commissioned:

• Abdominoplasty or apronectomy.
• Aesthetic surgery.
• Arm lift.

Commissioned but criteria applies

• Adenoidectomy.
• Alfa pumps for the removal of ascites due to liver disease.
• Annual MRI breast screening.
• Artificial urinary sphincters (AUS) for post-prostatectomy incontinence.
• Assisted conception (includes IVF).

B

Not routinely commissioned

• Benign skin lesions.
• Botox injection for the ageing face.
• Breast: asymmetry
• augmentation
• implants (removal and replacement)
• lift (mastopexy)
• reduction
• Brow lift.
• Buttock lift.

Commissioned but criteria applies

• Blepharoplasty.
• Bunion surgery (hallux valgus).

C

Not routinely commissioned

• Complementary medicines or therapies.
• Congenital ear deformity correction surgery including pinnaplasty.
• Correction of chest wall deformity for cosmetic purposes.
• Cosmetic genital procedures.

Commissioned but criteria applies

• Carpal tunnel syndrome release.
• Cataract surgery.
• Circumcision.
• Cholecystectomy.
• Chronic fatigue syndrome or myalgic encephalomyelitis referral for treatment.
• Closure of patent foramen ovale for migraine.
• Complex and specialised metabolic and bariatric surgery.
• Congenital vascular lesions.
• Continuous glucose monitors.
• Continuous positive airway pressure (obstructive sleep apnoea or hypopnoea syndrome).
• Cystoscopy for men with uncomplicated lower urinary tract symptoms.

D

Not routinely commissioned

• Dermabrasion of skin.
• Dermatology (acne and psoriasis).
• Dilatation and curettage for heavy menstrual bleeding in women.

Commissioned but criteria applies

• Desensitising light therapy in the management of severe polymorphic light eruption.
• Direct access DXA scanning to help target treatment in adults at potential risk of osteoporotic (fragility) fracture.
• Divarication of recti.
• Dupuytren’s contracture release in adults.

E

Not routinely commissioned

• Elective caesarean section for non-clinical reasons.
• Enhanced external counter-pulsation for patients with severe ischaemic heart disease.
• Extracorporeal shockwave therapy.

Commissioned but criteria applies

• Ear wax (removal in secondary care).
• Epididymal cysts.
• Excision of acromio-clavicular joint or arthroscopic surgical decompression of sub-acromial shoulder pain.
• Exogen ultrasound bone healing system.

F

Not routinely commissioned

• Face or brow lift.

Commissioned but criteria applies

• Female sterilisation.
• Flash glucose monitors.
• Functional electrical stimulator (skin surface applied) to correct foot drop of central neurological origin.

G

Not routinely commissioned

• Gynaecomastia.

Commissioned but criteria applies

• Gallstones.
• Ganglion excision.
• Grommets (insertion of).

H

Not routinely commissioned

• Hair depilation (hair removal).
• Hair grafting (male pattern baldness).
• Hymenorrhaphy.
• Hyperbaric oxygen therapy.
• Hyperhidrosis treatment.

Commissioned but criteria applies

• Haemorrhoidectomy.
• Hallux valgus (bunion surgery).
• Hernia management and repair in adults.
• Hip impingement syndrome.
• Hydroceles in males.
• Hysterectomy for heavy menstrual bleeding.

I

Not routinely commissioned

• Inverted nipple correction.

Commissioned but criteria applies

• Insertion of grommets.

K

Commissioned but criteria applies

• Knee arthroscopy:
  • diagnostic and therapeutic.
  • for patients with osteoarthritis.

L

Not routinely commissioned

• Labiaplasty.
• Laser hair removal for pilonidal disease.
• Laser surgery for short sight (myopia).
• Liposuction.

Commissioned but criteria applies

• Laparoscopic ventral rectopexy and STARR.
• Laryngeal or voice box surgery.

M

Not routinely commissioned

• Male breast reduction surgery for gynaecomastia.
• Mastopexy.
• Multifocal intraocular lenses in treatment of adults with cataracts.
• Multiple chemical sensitivity and clinical ecology and environmental medicine.

Commissioned but criteria applies

• Male sterilisation (vasectomy).
• Meibomian cysts (chalazia) removal.
• Mirena coils.
• Musculoskeletal corticosteroids injection.

O

Commissioned but criteria applies

• One-step nucleic acid amplification (intra-operative diagnostic method for detecting metastasis in breast cancer).
• Open magnetic resonance imaging (MRI) scanning.

P

Not routinely commissioned

• Percutaneous tibial nerve stimulation for urinary incontinence.
• Pinnaplasty.

Commissioned but criteria applies

• Paediatric speech and language therapy in secondary care.
• Polysomnography for children.
• Population screening outside of national screening committee guidelines.

R

Not routinely commissioned

• Removal of tattoos.
• Repair of lobe of external ear (split earlobes).
• Resurfacing procedures: dermabrasion, chemical peels and laser treatment.
• Reversal of sterilisation:
  • female
  • male
• Rhinoplasty.
• Routine doppler ultrasound of umbilical and uterine artery in antenatal care.

Commissioned but criteria applies

• Radiofrequency ablation for Barrett’s oesophagus.
• Radiofrequency denervation.
• Raised intraocular pressure.
• Removal of ear wax in secondary care.
• Replacement hearing aid.
• Revisional metabolic and bariatric surgery.
• Revision mammoplasty (including prosthesis removal or replacement).

S

Not routinely commissioned.

• Scars and keloids.
• Septorhinoplasty.
• Shave or surgical rhinophyma.
• Snoring in the absence of obstructive sleep apnoea.

Commissioned but criteria applies

• Single embryo transfer.
• Skin camouflage services.
• Skin surface applied functional electrical stimulation for an orthotic effect to correct foot drop of central neurological origin.
• Sperm washing.
• Spinal:
  • cord stimulation for chronic pain
  • fusion for chronic non-specific low back pain
  • injections for sciatica
• SpyGlass direct visualisation cholangioscopy in complex hepatopancreatic biliary disease.
• Surgical:
  • correction of strabismus or amblyopia in adults
  • intervention for chronic rhinosinusitis
  • intervention for benign prostatic hyperplasia
  • removal of kidney stone

T

Not routinely commissioned

• Testicular prosthesis.
• Thigh lift, buttock lift and arm lift, excision of redundant skin or fat.

Commissioned but criteria applies

• Tongue tie division.
• Tonsillectomy for recurrent tonsillitis.
• Trigger finger release in adults.

V

Not routinely commissioned

• Vaginoplasty.
• Venous angioplasty for multiple sclerosis.

Commissioned but criteria applies

• Varicose veins.
• Vasectomy.
• Vitreous floaters.