COSMETIC PROCEDURES FOR HAIR, SKIN AND SUBCUTANEOUS LESIONS POLICY

COSMETIC PROCEDURES FOR HAIR, SKIN AND SUBCUTANEOUS LESIONS POLICY

COSMETIC PROCEDURES FOR HAIR, SKIN AND SUBCUTANEOUS LESIONS POLICY Please note that all Clinical Commissioning policies are currently under review and elements within the individual policies may have been replaced by the pan Lancashire Clinical Commissioning Policies listed on the webpage. Please ensure that relevant pan Lancashire Clinical Commissioning Policies are read in conjunction with this Clinical C o m mis s i o n i n g Group Policy. REFERENCE NUMBER DCCE 15 APPROVING COMMITTEE(S) AND DATE Governance Committee AUTHOR(S) / FURTHER INFORMATION Associate Director Commissioning for Health & Well Being LEAD DIRECTOR Director of Commissioning and Community Engagement THIS DOCUMENT REPLACES Previous Policies for the predecessor organisations Chorley & South Ribble, Preston and West Lancashire PCT s REVIEW DUE DATE July 2016 RATIFICATION DATE/DRAFT No November 2008 VALIDATION SIGNATURE

West Lancashire Clinical Commissioning Group is committed to ensuring that, as far as it is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their age, disability, gender, race, religion/belief or sexual orientation. Should a member of staff or any other person require access to this policy in another language or format (such as Braille or large print) they can do so by contacting the communications department or the relevant policy holder. West Lancashire Clinical Commissioning Group will do its utmost to support and develop equitable access to all policies. Managers are responsible for ensuring staff within their area of responsibility are aware of W e s t L a n c a s h i r e C l i n i c a l C o m m i s s i o n i n g G r o u p policies and that staff adhere to them. Managers are responsible for ensuring that a system is in place for their area of responsibility that keeps staff up to date with new policy changes. Staff are responsible for ensuring they are familiar with policies, know where to locate the documents on the West Lancashire Clinical Commissioning Group website, and seek out every opportunity to keep up to date with them Independent contractors are expected to identify a lead person to be responsible for ensuring staff employed within their practice are aware of West Lancashire Clinical Commissioning Group policies. This policy is individual to West Lancashire Clinical Commissioning Group. W e s t L a n c a s h i r e C l i n i c a l C o m m i s s i o n i n g G r o u p does not accept any liability to any third party that adopts or amends this policy.

CONTENTS PAGE 1. INTRODUCTION 4 1.1 Scope 4 1.2 Principles 4 1.3 Exceptionality 5 2. COSMETIC PROCEDURES FOR HAIR, 5 SKIN AND SUBCUTANEOUS LESIONS POLICY 2.1 Context 5 2.2 Inclusion / Exclusion criteria 5 3. IMPLEMENTATION 7 4. REFERENCE DOCUMENTS 7 5. GLOSSARY 7

1. INTRODUCTION This is the policy of West Lancashire Clinical Commissioning Group to outline the commissioning of cosmetic procedures for hair, skin and subcutaneous lesions. This includes cosmetic surgery and non-surgical cosmetic treatments. The term 'cosmetic surgery' means operations that revise or change the appearance, colour, texture, structure or position of the bodily features to achieve what patients perceive to be more desirable. 'Non-surgical cosmetic treatments' means other procedures that revise or change the appearance, colour, texture, structure or position of the bodily features to achieve what patients perceive to be more desirable 1. This policy is written in recognition of service agreements that exist for the provision of cosmetic procedures for hair, skin and subcutaneous lesions and describes eligibility criteria for these procedures. Patients may satisfy the criteria, or may be confirmed as exceptions by W e s t L a n c a s h i r e C l i n i c a l C o m m i s s i o n i n g G r o u p on an individual patient basis. 1.1 Scope This policy applies to all those individuals who request a cosmetic procedure for hair, skin and subcutaneous lesions. Exceptional circumstances are considered when funding requests are received. This policy applies to health care for which West Lancashire Clinical Commissioning Group is the ultimate source of funds. It does not apply to health care provided to people who reside elsewhere, but who are referred to NHS Trusts for whom West Lancashire Clinical Commissioning Group is the lead commissioner. The policy will not apply where persons requesting the funding are registered with a General Practitioner within Central Lancashire but are non-resident in Central Lancashire. 1.2 Principles The principles that underpin this policy include the need for NHS Central Lancashire to commission interventions that are evidencebased, based on need and equitably accessible. The principles are outlined in more detail in a separate policy entitled: The Ethical Framework Policy for commissioning individual patient funding requests.

1.3 Exceptionality The Panel will consider the exceptionality of the case when considering funding requests. For the purposes of the policy, exceptionality is taken to mean that the patient is different in their needs compared to other patients with a similar condition requiring an intervention. 2. COSMETIC PROCEDURES FOR HAIR, SKIN AND SUBCUTANEOUS LESIONS POLICY 2.1 Context The NHS will not pay for surgery for cosmetic reasons alone. However, reconstructive surgery and cosmetic surgery to correct or improve congenital abnormalities and injuries may be undertaken free of charge. 2.2 Inclusion / exclusion criteria The following procedures are not routinely available for NHS funding: Correction of hair loss (Alopecia) Correction of male pattern baldness Hair transplantation Tattoo removal Treatment for skin hypo-pigmentation Removal of Xanthelasma Removal of spider naevi or thread veins Skin resurfacing techniques Hair depilation (hair removal) This treatment is available and provided only for visible areas where the following are fulfilled: Those with a proven underlying endocrine disturbance resulting in hirsutism (e.g. polycystic ovary syndrome). In the opinion of the patients GP / specialist consultant, the amount of body hair is excessive and beyond normal limits. The patient is suffering significant psychological distress because of the excess body hair and this distress is sufficient to require medical or psychological treatment. Or Are undergoing treatment for pilonidal sinuses to reduce recurrence.

Fatty lumps (Lipomata) Removal of Lipomata are only funded in exceptional circumstances for example: The lipoma (-ta) is / are symptomatic There is functional impairment The lump is rapidly growing or abnormally located (e.g. sub-fascial, submuscular) Excision biopsy is necessary for diagnosis Other benign skin lesions Clinically benign skin lesions will not be removed routinely on purely cosmetic grounds. This will include, amongst other conditions, skin tags and seborrhoeic keratoses (warts). Removal of benign skin lesions are only funded in exceptional circumstances for example: Patients with moderate to large lesions that cause actual facial disfigurement, if the proposed procedure is considered clinically appropriate and expected to achieve a significant benefit. Excision biopsy is necessary for diagnosis. Vascular skin lesions NHS treatment is allowed for all vascular lesions except for small benign, acquired vascular lesions such as thread veins and spider naevi. Acne vulgaris Treatment of active acne vulgaris should be provided in primary care or through a dermatology service. All other treatments are not available on the NHS. Rhinophyma(severe acne rosacea) The first-line treatment is medical. All other treatments are not available on the NHS. Botulinum toxin Botulinum toxin therapy is not routinely available except for the treatment of pathological conditions by appropriate specialists in cases such as: Frey s syndrome Blepharospasm Cerebral palsy Botulinum toxin is not available for the treatment of facial ageing or excessive wrinkles.

3. IMPLEMENTATION Line Managers will ensure that all staff involved in processing commissioning requests in Public Health, Health Standards and Commissioning Directorates will follow the policy. This policy will be available to all General Practitioners and service providers. The policy will be available from the West Lancashire Clinical Commissioning Group website. Any breaches to this policy will be monitored through the Commissioning Appeals Process and reported to the Governance Committee. 4. REFERENCE DOCUMENTS 1 Department of Health: Cosmetic Procedures Frequently Asked Questions. http://www.dh.gov.uk/en/publichealth/cosmeticsurgery/index.htm?i dcservice=get_file&did=139989&rendition=web 5. GLOSSARY Not required.