Lipoma Abdominoplasty Scar Reduction Refer Refer Refer R R R Cosmetic Procedure Referral Ilkeston CAS Approved Not Approved CAS/GP to refer GP to communicate to patient Page 1 of 5
4 Lipomas that are under 5cms should be observed only, using Soft Tissue Sarcoma Guidelines (SIGN 2003). (N.B. Lipomas located on the body that are over 5cms in diameter, or in a sub-facial position, which have also shown rapid growth and/or are painful should be referred to an appropriate Sarcoma clinic). 5 The Commissioner will only fund abdominoplasty (irrespective of the cause of the apron or reason for previous weight loss) when ALL the following criteria are met: 1. Sexual maturation has been reached. 2. An abdominoplasty/apronectomy has not already been performed 3. Body Mass Index (BMI) as measured by the NHS is between 18 and 25 and has been within this range for 1 year as measured and recorded by the NHS 4. Confirmed non-smoker and/or documented abstinence prior to procedure 5. Photographic evidence 6. Functionally disabling resulting in severe restrictions in activities of daily living[1] Surgical outcomes (e.g. wound healing, complications etc) can be adversely affected by smoking. To ensure the best outcomes, patients should have stopped smoking prior to surgery. Smoking status may be validated at pre-operative appointment using an appropriate test. Support to stop smoking is available to patients through a range of NHS stop smoking services. [1] 6 The Commissioner will fund repair of or injection/application of topical treatment for keloid scars that result from burns, trauma, keloid formation or surgery when one or more of the following clinical criteria are met: 1. Scar is functionally disabling, or 2. Scar results in facial disfigurement. 10 Cosmetic Procedure Referral For those practices not using the e-referral system, paper referrals will need to be addressed to: Private and Confidential Roz Puzey Clinical Nurse Specialist NHS Derbyshire CAS for Cosmetic Procedures Toll Bar House Derby Road Ilkeston Derbyshire DE75FH All referrals for patients need to be assessed in the first instance by the NHS Derbyshire CAS for Cosmetic Procedures before referral to a secondary care provider. Page 2 of 5
This is a Nurse led Clinical assessment service which can be found in e-referral - under the speciality of "surgery - plastic" and the clinic types of - "Not Otherwise specified" - "minor plastic surgery and laser". The service is called "NHS Derbyshire CCG Nurse Led CAS for Cosmetic Procedures for all ages". Please note: all patient referrals should include the following information: Smoking status (should be a confirmed non-smoker and/or documented evidence prior to procedure) Current BMI (which should be between 18-25 and within this range for 1 year as measured and recorded by the NHS). Please note that this service is directly bookable, so you will need to ensure that the patient thas been given the e-referral system appointment request paperwork, asking them to contact the CAS. If the patient doe snot contact the CAS to initiate the referral, the requestr will remain on your worklist un-blooked. The patient will be required to telephone the CAS at Toll Bar House quoting their e- Referral UBRN (Unique Booking reference Number). This will then be activated on the system. 11 Ilkeston CAS Once a referral has been activated it will be assessed by the Clinical Nurse Specialist and the patient/gp will be advised of the outcome within 15 days. Patients may be required to attend for medical photography or 3D body scans to complete the assessment procedure. Time Scale for Medical Photography/3D Body Scans Royal Derby Hospital - patient will be sent a letter to book an appointment for medical photography, which the patient should attend within 5 working days of receipt of letter. Royal Hallamshire Hospital - the medical photography department will contact the patient to make an appointment. SK:N Clinic Mapperley (3D Body Scans) - the clinic will contact the patient to make an appointment. Pateint should attend within 10 working days of receipt of letter. If patient does not attend within the timescale the referral will be cancelled and the GP will be informed. Any medical photography/breast scans that are required for patients will be arranged by the nurse and in some cases this information will need to be considered by a panel which will include primary and secondary care advisors. Once a decision has been made the decision will be conveyed to the GP via the e-referral system if appropriate/and or letter. 12 Approved The patient will be sent a letter either with the outcome or in some cases to contact the GP for the outcome. If funding is approved the patient will be offered an appointment at a hospital of their choice which will be booked directly via the e-referral system/or the GP will be requested to refer patients to a hospital of their choice (if not originally referred via e-referral). 13 Not Approved If a request is declined the East Midlands Commissioning Policy for Cosmetic Procedures does not provide a right of appeal and does not provide a right to request that the decision should be reviewed. However, the patient has a right to make a complaint about the policy under the NHS Complaints Procedure. However, if a requesting clinician believes they have significant new clinical evidence that they did not provide in their first submission which they feel may make a difference to the decision made, they will need to submit a new referral with this evidence. Page 3 of 5
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Key Dates Published: 14-Sep-2016, by Valid until: 14-Sep-2017 Evidence summary for Cosmetic Procedures - Surgery Page 5 of 5