Commissioning Policy Individual Funding Request Facial Surgery and Treatments Individual Funding Requests Policy Date Adopted: 4 th November 2016 Version: 1617.1.01 Individual Funding Request Team Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group
Document Control Title of document Authors job title(s) Facial Surgery and Treatments IFR Manager Document status v.1617.1.01 Supersedes Surgery of the face v1516.1 Clinical approval May 2016 Discussion and Approval by 13 th July 2016 Clinical Policy Review Group (CPRG) Discussion and Approval by CCG 27 th September 2016 Board Date of Adoption: 4 th November 2016 Publication/issue date 4 th November 2016 Review date November 2019 Equality Impact Assessment Internal Version Date Reviewer Comment v1617.1.01 26/03/2018 IFR Coordinator Rebranded to BNSSG CCG Version: v1617.1.01 Page 2
THIS TREATMENT IS NOT ROUTINELY COMMISSIONED FOR ANY PATIENTS AND INDIVIDUAL FUNDING PANEL APPROVAL MUST BE SOUGHT PRIOR TO REFERRAL - THIS POLICY RELATES TO ALL PATIENTS Facial Surgery and Treatments Policy Statement & Date of Adoption: 4th November 2016 Facial Surgery is not routinely funded by the CCG. General Principles Funding approval will only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval will not be given. 1. The CCG does not commission surgery for cosmetic purposes alone. 2. Funding approval must be secured by primary care prior to referring patients seeking corrective surgery. Referring patients to secondary care without funding approval having been secured not only incurs significant costs in out-patient appointments for patients that may not qualify for surgery, but inappropriately raises the patient s expectation of treatment. 3. On limited occasions, the CCG may approve funding for an assessment only in order to confirm or obtain evidence demonstrating whether a patient meets the criteria for funding. In such cases, patients should be made aware that the assessment does not mean that they will be provided with surgery and surgery will only be provided where it can be demonstrated that the patients meets the criteria to access treatment in this policy. 4. Where funding approval is given by the Individual Funding Panel, it will be available for a specified period of time, normally one year. 5. Funding approval will only be given where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where it is demonstrated that patients have previously been provided with the treatment with limited or diminishing benefit, funding approval is unlikely to be agreed. 6. Patients unhappy with results of self-funded facial surgery should be advised that they should seek resolution from the service provider the NHS will not normally fund resolution in these cases. 7. Patients with an elevated BMI of 30 or more are likely to receive fewer benefits from surgery and should be encouraged to lose weight further prior to seeking surgery. In addition, the risks of surgery are significantly increased. (Thelwall, 2015) 8. Patients who are smokers should be referred to smoking cessation services in order to reduce the risk of surgery and improve healing. (Loof S., 2014) Version: v1617.1.01 Page 3
Background Facial Surgery (The British Association of Aesthetic Plastic Surgeons (BAAPS)) can relate to any procedure to alter the appearance of a patients face including: Brow lift Cosmetic facial injections Facelift or Rhytidectomy Laser Surgery for sun damage, ageing and wrinkles Lip Enhancement including lipotransfer Reshaping of the Cheek including implants and lipotransfer Reshaping of the Chin including Implants and lipotransfer These procedures would normally be considered cosmetic and are not routinely funded by the NHS. Cleft Palate - NHS England commissions specialist services relating to cleft lip/palates and complex congenital disorders (NHS England D.07) Burns Care - NHS England commissions specialist services relating to burns care including surgical reconstruction (NHS England D.06) Policy - Criteria to Access Treatment INDIVIDUAL FUNDING REQUEST APPROVAL REQUIRED Facial surgery and/or treatments are not routinely commissioned. Patients who are unhappy with their appearance to an extent that they could be said to be suffering from body dysmorphia (NHS Choices) may wish to be considered for a referral to commissioned mental health services (Avon and Wiltshire Mental Health Partnership NHS Trust (AWP)) to support them in managing their underlying condition. Surgery is not commissioned to manage body dysmorphia. Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the restrictions of this policy. Individual cases will be reviewed at the CCG s Individual Funding Request Panel upon receipt of a completed application form from the patient s GP, consultant or clinician. Applications cannot be considered from patients personally. Version: v1617.1.01 Page 4
If you would like further copies of this policy or need it in another format, such as Braille or another language, please contact the Patient Advice and Liaison Service on 0800 073 0907 or 0117 947 4477. Connected Policies A number of procedures on or near the face, or which can impact on the face, are managed through connected policies, including: Benign Skin Lesions Policy: Treatment will not be offered under this policy. Clinician s should refer to the Blepharoplasty Policy: Treatment will not be offered under this policy. Clinician s should refer to the Botulinum Toxin Treatment: Treatment will not be offered under this policy. Clinician s should refer to the Chalazion Removal: Treatment will not be offered under this policy. Clinician s should refer to the Congenital Ear Deformity Policy: Treatment will not be offered under this policy. Clinician s should refer to the Cosmetic Surgery: Treatment will not be offered under this policy. Clinician s should refer to the External Ear (pinna) and lobe repair: Treatment will not be offered under this policy. Clinician s should refer to the Hair Removal Treatment: Treatment will not be offered under this policy. Clinician s should refer to the Hyperhydrosis Treatment: Treatment will not be offered under this policy. Clinician s should refer to the Laryngeal Surgery (voice box): Treatment will not be offered under this policy. Clinician s should refer to the Laser Surgery for Refractive Error: Treatment will not be offered under this policy. Clinician s should refer to the Liposuction to reduce fat pockets & deposits: Treatment will not be offered under this policy. Clinician s should refer to the Nasal Surgery Policy including Rhinoplasty: Treatment will not be offered under this policy. Clinician s should refer to the Skin Camouflage: Treatment will not be offered under this policy. Clinician s should refer to the Skin contouring: Treatment will not be offered under this policy. Clinician s should refer to the Tattoo removal: Treatment will not be offered under this policy. Clinician s should refer to the Wigs, hairpieces and hair replacement systems: Treatment will not be offered under this policy. Clinician s should refer to the Version: v1617.1.01 Page 5
This policy has been developed with the aid of the following references: Avon and Wiltshire Mental Health Partnership NHS Trust (AWP). (n.d.). Retrieved 05 17, 2016, from Avon and Wiltshire Mental Health Partnership NHS Trust (AWP): http://www.awp.nhs.uk/ Loof S., D. B. (2014). Perioperative complications in smokers and the impact of smoking cessation interventions [Dutch]. Tijdschrift voor Geneeskunde, vol./is. 70/4(187-192. NHS Choices. (n.d.). Body dysmorphic disorder (BDD). Retrieved 05 17, 2016, from NHS Choices: http://www.nhs.uk/conditions/body-dysmorphia/pages/introduction.aspx NHS England D.06. (n.d.). D06. Burn Care. Retrieved 05 17, 2016, from NHS England: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d06/ NHS England D.07. (n.d.). Cleft Lip & Palate. Retrieved May 17, 2016, from NHS England: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d07/ The British Association of Aesthetic Plastic Surgeons (BAAPS). (n.d.). Procedures. Retrieved May 17, 2016, from http://baaps.org.uk/: http://baaps.org.uk/ Thelwall, S. P. (2015). Impact of obesity on the risk of wound infection following surgery: results from a nationwide prospective multicentre cohort study in England. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases,, vol. 21, no. 11, p. 1008.e1. Approved by (committee): Clinical Policy Review Group Date Adopted: 4th November 2016 Version: 1617.1.01 Produced by (Title) EIA Completion Date: Review Date: Commissioning Manager Individual Funding Undertaken by (Title): Earliest of either NICE publication or three years from approval. Version: v1617.1.01 Page 6