Abdominoplasty (tummy tuck) is an operation to remove excess skin and fat from the abdomen. An apronectomy is a less extensive procedure that only removes excess skin and fat from the lower abdomen.

You can view the current policy here: Policy for Cosmetic Procedures - 7. Abdominoplasty/Apronectomy: Restricted

The policy, although worded as ‘not routinely commissioned’ has new criteria that should allow more people to have procedure. The policy allows apronectomy alone for patients who are unable to slim down to a BMI of less than 30 kg/m² but have lost 75% of the excess body weight.

The main changes to the current policy are; an increase in the BMI criteria from no more than 27 to less than 30, a lower age limit of 18 years of age, and the addition of specific criteria for apronectomy alone. This is in keeping with guidance from the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

The proposed policy is being revised to have the following wording:

Apronectomy or abdominoplasty are not routinely commissioned unless ALL the following criteria are met:-

1. Patient is aged 18 years or above
2. The current BMI has remained stable for at least 12 months and is <30 kg/m²
3. The previous BMI was >40 kg/m² (or >35 kg/m² with comorbidities)
4. There is no previous diagnosis of body dysmorphic disorder
5. Patient is a non-smoker and there are no ongoing alcohol or drug misuse problems
6. There is inflammation and/or infection of the skin folds (intertrigo) with breakdown of the integrity of the skin. This will be demonstrated by evidence of cellulitis, skin ulceration, abscesses, lymphoedema, skin necrosis or equivalent which have been a clinically chronic† problem despite compliance with nonsurgical treatment (e.g. meticulous skin hygiene; dressings; clothing that minimizes skin fold contact; topical antifungal agents, antibiotics or corticosteroids as clinically appropriate).

Apronectomy alone will be commissioned if the patient fulfils ALL of the criteria above but is unable to slim down to a BMI of <30 kg/m² AND

1. The current BMI is not >40 kg/m² and has remained stable for at least 12 months
2. Either the current BMI is 30.0 – 35.0 kg/m2 OR the current BMI is 35.1 – 40.0 kg/m² and the patient has lost 75% of the excess‡ body weight.

Exclusions

• Patients’ suffering from problems associated with poorly fitting stoma bags are outside of this policy.
• “Chronic” is usually defined as a period of not less than 3 months.
• Excess weight = change of BMI relative to a maximum normal BMI of 25kg/m2 [Calculation is: 100 x (Pre-op BMI – Current BMI) / 25]

Share your thoughts here. https://www.smartsurvey.co.uk/s/AbdominoplastyorApronectomyClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Breast Augmentation is a common surgical procedure that increases the size and shape of your breasts using breast implants or fat transfer.

You can view the current policy here: You can view the current policy here: Policy for Cosmetic Procedures - 2. Breast Augmentation: Not routinely funded

Previously the procedure was not commissioned (paid for) by the NHS Lancashire and South Cumbria Integrated Care Board however, in line with new recommendations from the NHS modernisation agency, it will now be commissioned under certain conditions.

The proposed policy wording is:

Breast augmentation is not routinely commissioned for cosmetic purposes unless all of the following criteria apply:- 

1. patient has a proven congenital condition such as amazia or amastia  

AND  

2. condition is bilateral (both sides).  

N.B. For unilateral conditions, please see policy on breast symmetrisation. 

Exclusions 

• Any procedures which are being performed as part of oncoplastic reconstruction are outside the scope of this commissioning statement and are routinely commissioned.

Share your thoughts here: https://www.smartsurvey.co.uk/s/BreastAugmentationClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Also known as reduction mammaplasty, breast reduction surgery removes fat, breast tissue, and skin from the breasts to ease discomfort and improve appearance.

View the current policy here: Commissioning Policy:

The proposed policy is virtually the same as the current Lancashire and South Cumbria policy, with an important difference regarding the maximum permitted BMI. Whereas the current policy recommends a maximum BMI of less than 27 kg/m², in the proposed policy, this has been increased to less than 30 kg/m² as per the Royal College of Surgeons guidance. This means more people will be eligible.

The proposed wording of the policy is:

1. Breast reduction is not routinely commissioned for cosmetic purposes only
2. Breast reduction is only commissioned when all of the following criteria are met:-
   1. The woman has received a full package of supportive care such as advice on weight loss and managing pain and in cases of thoracic/ shoulder girdle discomfort, a physiotherapy assessment has been provided prior to referral to secondary care

AND

1. 2. Breast size results in functional symptoms that require other treatments/interventions (e.g. intractable candidal intertrigo; thoracic backache/kyphosis where a professionally fitted bra (where physically possible) has not helped with backache, soft tissue indentations at site of bra straps)

AND

1. 3. Breast reduction planned to be 500gms or more per breast or at least 4 cup sizes

AND

1. 4. Body mass index (BMI) does not exceed 30 kg/m² and has been stable for at least twelve months

AND

1. 5. The woman must be provided with written information to allow her to balance the risks and benefits of breast surgery

AND

1. 6. Women should be informed that breast surgery for hypermastia can cause permanent loss of lactation.

Exclusions

• Any procedures which are being performed as part of oncoplastic reconstruction are outside the scope of this commissioning statement and are routinely commissioned.

Share your thoughts here: https://www.smartsurvey.co.uk/s/BreastreductionClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Breast symmetrisation surgery is a procedure designed to improve balance and symmetry between the breasts, often performed after breast cancer treatment or for congenital or developmental breast asymmetry.

You can view the current policy here: Policy for Cosmetic Procedures - 4. Surgical correction of breast asymmetry: Not routinely funded

Reflecting guidance from the Modernisation Agency, British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) the policy is an increase in provision with a shift from a ‘not routinely commissioned’ position to criteria-based commissioning. The proposed policy supports symmetrisation surgery for congenital breast asymmetry. Patients who meet defined clinical thresholds will now be eligible for treatment.

The proposed policy wording is as follows:

1. Breast symmetrisation surgery is not routinely commissioned for cosmetic purposes alone. 
2. Breast symmetrisation surgery will be commissioned in women if all of the following criteria are met:  
   1. the woman is aged at least 18 years  

AND  

1. 2. BMI does not exceed 30kg/m2 and has been stable for at least 12 months  

AND  

1. 3. breast asymmetry (with an estimated difference of 3 cup sizes or more, (approximately 300g in weight) has been confirmed by a breast specialist  

AND  

2. 4. the asymmetry is thought to have resulted from:-  macromastia, Poland Syndrome, tuberous breast, unilateral or asymmetric hypoplasia, unilateral amazia, congenital symmastia.  
3. If there is less than 3 cups sizes the difference between the breasts, symmetrisation breast surgery will only be offered if there is a clear tubular deformity of one breast. In these cases, the breast base diameter of the tubular breast must measure less than 50% of the contralateral breast.  

N.B For bilaterial congenital condition such as amazia please refer to the LSC Breast Augmentation Commissioning Statement 

Additional requirement for all patients 

NHS specialist breast surgeons in Lancashire and South Cumbria are reluctant to offer aesthetic breast surgery in smokers due to the associated increased risk of complications such as poor wound healing rates. Referring clinicians are requested to ensure the patient is a non-smoker or has stopped smoking for at least one month before referral (this includes all nicotine-based products e.g. cigarettes, vapes, e-cigarette, nicotine replacement). 

Exclusions 

• Any procedures which are being performed as part of oncoplastic reconstruction are outside the scope of this commissioning statement and are routinely commissioned.

Share your thoughts here: www.smartsurvey.co.uk/s/Breastsymmetrisationsurgeryclinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Complementary and alternative therapies are health care approaches that are not typically part of conventional medical care. Complementary therapies are used alongside conventional medicine, while alternative therapies are used in place of conventional medicine.

View the current policy here: Commissioning Policy:

The previous policy only commissioned (paid for) therapies where there was clear evidence of effectiveness and not as standalone treatments. The new policy adds a requirement that any complementary or alternative therapy is delivered by a therapist who is registered with a statutory regulatory body.

Requiring statutory regulation may exclude practitioners in therapies where regulation is voluntary or not well established.

The new wording of this policy is:

1. The ICB will commission complementary and alternative therapies when:
   1. There is robust evidence of clinical and cost effectiveness in relation to the specific clinical indication. This may be evidenced by a National Institute for Health and Care Excellence (NICE) recommendation that the therapy be offered by the NHS. Where an intervention is offered based on a recommendation by NICE, the NICE guidance should be followed.

AND

1. 2. They are delivered by an agreed NHS provider as part of an existing NHS pathway of care (e.g. as part of end-of-life care; pain management; musculoskeletal services).

AND

1. 3. The training and practice of the therapist is regulated by a statutory regulatory body.
2. The ICB will not commission complementary and alternative therapies as “stand alone” treatments either within or outside of the NHS.

Scope and definitions:

This policy addresses a wide range of healthcare services that are often regarded as being outside the scope of conventional medical practice and are often used alongside or instead of standard treatment. Such therapies tend to be non-invasive and non-pharmaceutical, and they often take a holistic approach to the patient.

The scope of this policy includes requests for:

1. Professionally organised alternative therapies
   1. Acupuncture
   2. Chiropractic
   3. Herbal medicine
   4. Homeopathy
   5. Osteopathy
2. Complementary therapies
   1. Alexander Technique
   2. Yoga
   3. Aromatherapy
   4. Bach and other flower remedies
   5. Maharishi Ayurvedic Medicine
   6. Meditation
   7. Reflexology
   8. Shiatsu
   1. Nutritional medicine
   10. Hypnotherapy
   11. Shiatsu Body work therapies, including massage
   50. Healing
   1000. Counselling stress therapy
3. Alternative disciplines.
   1. Anthroposophical medicine
   2. Ayurvedic medicine
   3. Chinese herbal medicine
   4. Eastern medicine
   5. Naturopathy
   6. Traditional Chinese medicine
   7. Crystal therapy
   8. Dowsing
   1. Iridology
   10. Kinesiology
   11. Radionics

This policy’s principles may be applied to other therapies with similar characteristics that are considered ‘alternative’ or ‘complementary’.

Complementary and alternative therapies are referenced in many pieces of NICE guidance. They are specifically recommended as part of NHS treatment pathways in the following pieces of guidance:

Share your thoughts here: www.smartsurvey.co.uk/s/ComplementaryandAlternativeTherapiesClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

The is a genetic disorder that makes the tissue under the skin of your palms and fingers thicken and tighten, leading to bent fingers that cannot straighten completely.

View the current policy here: Commissioning Policy:

The policy has been revised to reflect the withdrawal of collagenase clostridium histolyticum from the European market. Other key changes include the removal of requirements for the contracture degree and the introduction of mandatory patient counselling on treatment options. Surgery eligibility now requires functional impairment or rapid disease progression. Amputation has also been added as a treatment option, counselling must reference specific surgical techniques, and examples of functional impairment have been included to support prior approval decisions.

The new policy wording is proposed as:

1. Needle fasciotomy, limited fasciectomy, dermofasciectomy and amputation for Dupuytren’s disease are routinely commissioned when:
   1. There is a contracture that significantly impairs function (for example, the use of the fingers is significantly impacted)

OR

1. 2. There is rapidly progressive disease.
2. The following information about the specific surgical technique chosen should be discussed with the patient:
   1. The likelihood of recurrence
   2. The risk of complications
   3. The length of wound healing and probability of scarring
   4. The likelihood that surgery will not result in complete resolution.

Exclusions

• Collagenase injections have been excluded from this policy, as they are no longer available in the UK

Share your thoughts here: www.smartsurvey.co.uk/s/DupuytrensContractureClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

This policy covers the supply of wigs for individuals who have lost their hair due to medical conditions or treatments.

You can view the current policy here: Policy for Cosmetic Procedures - 15. Provision of wigs: Restricted

The main change to policy is the broadening of eligibility criteria. The new policy would allow access to wigs for people with scarring alopecia or alopecia areata. This would mean more people are eligible.

The proposed policy states:

1. The ICB will commission wigs for the correction of hair loss associated with the following conditions:
   1. Treatment for cancer
   2. Severe alopecia areata with a SALT score1 of at least 50. (SALT is the Severity of Alopecia Tool. It is the tool accepted by the National Institute for Health and Care Excellence (NICE) to measure hair loss. A SALT score of 50 is regarded as severe for patients with alopecia areata.​)
   3. Scarring alopecia with a SALT score of at least 30.
   4. Scarring of the scalp caused by trauma.
2. Funding will normally be provided for one device per patient. Replacements will be offered not more frequently than 2 acrylic wigs per annum OR once every two years for human hair wigs.
3. Replacements will be subject to assessment of continuing need. Wigs are funded as per the NHS tariff: https://www.nhs.uk/nhsservices/help-with-health-costs/wigs-and-fabric-supports-on-the-nhs

Share your thoughts here: www.smartsurvey.co.uk/s/ProvisionofwigsClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

This policy covers surgery to treat fluid build-up in the middle ear, often involving the insertion of grommets (tiny tubes) to drain the fluid.

View the current policy here: Commissioning Policy:

This revision is one that will increase provision. It includes a general statement on assessment and recognition of patients with OME and links to relevant National Institute for Health and Care Excellence (NICE) guidance (NG233, incorporating the latest evidence and guidance).

The new policy reads:

1. Surgical intervention should be given equal consideration as management of hearing loss (i.e. hearing aids).
2. Surgical management (insertion of grommets or tympanostomy tubes) is routinely commissioned if the following criteria are satisfied:-
   1. In a child with 3 months of bilateral (i.e. in both ears) hearing loss

OR

1. 2. In a child with 3 months of unilateral ie (one ear) hearing loss which is impacting on daily living or communication

OR

1. 3. In any child with unilateral or bilateral hearing loss which is impacting on daily living or communication before the 3 months’ assessment

AND

2. 4. In all cases (2a – 2c above), the benefits and harms of choosing either grommet surgery and hearing aids were fully discussed and a shared decision made to proceed by the clinician, child and their parents or guardians.
3. Unless contra-indicated, adenoidectomy is routinely commissioned when all of the following criteria are satisfied:-
   1. The child is listed for surgical insertion of grommets

AND

1. 2. Adenoidectomy will be performed during the grommet insertion procedure

AND

1. 3. The benefits and harms of adjuvant adenoidectomy were fully discussed and a shared decision made to proceed by the clinician, child and their parents or guardians.

Exclusions

The following conditions are considered outside the scope of this policy and thus are excluded:_

• Suspected cholesteatoma.
• Chronic suppurative otitis media.
• Adenoidectomy performed for indications not related to OME (eg sleep apnoea, chronic rhinosinusitis, nasal obstruction, speech surgery in cleft palate).
• Retraction of ear drum without effusion

Share your thoughts here: www.smartsurvey.co.uk/s/SurgicalmanagementofOtitisMediawithEffusionOMEClinicalpoliciesquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

This is a surgery to treat an enlarged prostate, which can cause urinary problems in men.

View the current policy here: Commissioning Policy:

The new policy allows surgery for all lower urinary tract symptoms, not just voiding symptoms.  The new policy increases the indications for surgery. As per the European Association of Urology and other guidance.

The proposed new wording is as follows:

1. Surgical intervention for bladder outflow obstruction resulting from benign prostatic hyperplasia (BPH) is commissioned when the patient has any one of the following: 
   1. Continuing lower urinary tract symptoms despite non-surgical treatment 
   2. Recurrent or refractory urinary retention 
   3. Recurrent UTIs 
   4. Bladder stones 
   5. Bladder diverticula associated with complications 
   6. Treatment-resistant haematuria due to BPH 
   7. Dilatation of the upper urinary tract due to prostatic obstruction, with or without renal insufficiency. 
2. The man must be fully counselled regarding alternatives to surgery, and the physical, emotional, psychological and sexual outcomes from surgery. Careful consideration should be given to the choice of surgical technique, which should be determined by the clinical presentation, local availability and patient preference. 

The following are excluded and are not restricted by the policy: 

• Surgery for other prostate pathology, including suspected or confirmed malignancy. 

Share your thoughts here: www.smartsurvey.co.uk/s/SurgicalManagementofBenignProstaticHyperplasiaBPHclinicalpoliciesquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Also known as a stress test, this test records the heart's electrical activity, blood pressure, and heart rate while you exercise, usually by walking on a treadmill.

This is a new policy as there currently is not one in Lancashire and South Cumbria. The proposed policy is evidence based and reads:

1. Exercise electrocardiogram (ECG) is not routinely commissioned as a screening test for coronary heart disease in asymptomatic and low risk patients.

Exclusions:

• This policy applies to adults aged 18 and over.

Share your thoughts here: www.smartsurvey.co.uk/s/ExerciseECGClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Pinnaplasty is a surgical procedure to correct prominent or protruding ears, often performed on children and adolescents.

You can view the current policy here: Policy for Cosmetic Procedures - 10. Pinnaplasty: Not routinely funded

The proposed policy changes involve transitioning from a "not routinely funded” policy stance to establishing specific criteria tailored for children and adolescents. This aims to provide clearer guidelines and improved access to services or interventions for this age group.

The proposed policy update has the following wording:

1. Pinnaplasty is routinely commissioned in children and adolescents with prominent ear if they meet ALL of the following criteria: 
   1. The patient is aged 7 years to <18 years 
   2. The prominent ear, upper 3rd mastoid – helical distance is ≥21.5 mm
   3. During the clinical assessment, a consultant surgeon can verify that the child is suffering from significant psychological distress due to their prominent ears (in cases of bullying/teasing at school, provision of documented evidence from the head teacher [or equivalent] will complement this assessment)
   4. The child and parent understand the risks, likely outcome and are motivated to proceed with surgery. 
2. Pinnaplasty is also routinely commissioned in children and adolescents if there are functional reasons for the procedure, such as the need to keep a hearing aid in place or ears folding over when asleep causing pain. 
   1. Otherwise, all other cases of pinnaplasty are considered to be cosmetic and will not be routinely commissioned. 

Exclusions 

• Children who require reconstruction as a result of trauma or cancer are excluded from this policy. 

Share your thoughts here: www.smartsurvey.co.uk/s/PinnaplastyinyoungchildrenandadolescentsClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Blepharoplasty is a type of surgery that repairs droopy eyelids and may involve removing excess skin, muscle, and fat.

You can view the current policy here: Policy for Cosmetic Procedures - 11. Blepharoplasty: Restricted

The updated blepharoplasty policy introduces a DVLA-aligned visual field threshold and expands eligibility to include a broader range of eyelid pathologies. Subjective measures have been removed in favour of objective visual field assessments, and ocular surface disease has been reinstated. This may mean that some people are no longer eligible for this procedure.

The proposed wording of the updated policy is:

1. Blepharoplasty is not commissioned for aesthetic purposes.
2. If a patient has symptoms attributable to dermatochalasis which have not responded to conservative management, upper lid blepharoplasty is commissioned for:
   1. Visual field restriction clearly caused by excess skin, measured using Esterman/driving fields, whereby the eyelids impinge on the individual’s visual fields reducing that field to 120° or less laterally (with a minimum of 50° to left and to right) and/or 20° or less superiorly

OR

1. 2. Eyelid or eyelash pathology caused by excess skin (for example periocular dermatitis, wick syndrome)

OR

1. 3. Ocular surface disease caused by excess skin.

OR

1. 4. Severe unilateral dermatochalasis causing significant visual loss and functional impairment.

OR

2. 5. There is photographic evidence of frontalis overaction caused by dermatochalasis.
3. Brow lift is commissioned as an adjunct to blepharoplasty when:
   1. Brow ptosis is a major contributor to the reduced visual field
   2. There will be significant uncorrected visual field loss if blepharoplasty alone is carried out.
   3. Lower lid blepharoplasty is not routinely commissioned.
4. The following are excluded and are therefore not restricted by this policy:
   1. Thyroid eye disease
   2. Ptosis correction
   3. Surgical treatment of lower lid pathology, for example, ectropion.
   4. Malignancy
   5. Children aged under 18 years

Share your thoughts here: www.smartsurvey.co.uk/s/BlepharoplastyCosmeticClinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

Hip arthroscopy is a minimally invasive surgery used to treat issues in the hip. It involves making small incisions and using an arthroscope to identify and repair damage inside the hip joint.

View the current policy here: Commissioning Policy:

The revised policy proposes to be an increase in provision since the old policy was to not commission the procedure as it was not seen to be effective. However, the recommended policy statement is specifically for FAI syndrome, so the policy title has been amended to “Hip arthroscopy for the treatment of Femoroacetabular Impingement Syndrome.”

The newly proposed policy wording says:

1. This policy specifically relates only to the use of hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome.
2. Arthroscopic surgery for the treatment of FAI syndrome is routinely commissioned for patients meeting all of the following criteria: 
   1. A clinical diagnosis of FAI syndrome has been made on the basis of symptoms, clinical signs and imaging findings. 
   2. There has been no improvement in symptoms following appropriate conservative treatment, including activity modification, pharmacological intervention and physiotherapy. 
   3. There is no evidence of osteoarthritis and there are no other contraindications to surgery. 
   4. The patient is referred to a surgeon who is experienced in the provision of hip arthroscopy and normal arrangements are in place for clinical governance, consent and audit. 

Share your thoughts here: www.smartsurvey.co.uk/s/HiparthroscopyforthetreatmentofFemoroacetabularImpingementSyndromeclinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

This policy relates to procedures to relieve low back pain by injecting medication into the spine or using radiofrequency energy to disrupt nerve function.

View the current policy here: Commissioning Policy:

The proposed changes broaden the definition of spinal injections that are not routinely commissioned and introduces exclusion criteria. This is based on National Institute for Health and Care Excellence (NICE) guidance on out of scope criteria for this procedure. The changes may mean fewer people are eligible for the criteria.

The proposed policy wording includes two options (A or B below) which will be decided based on feedback received from the public.

The wording is as follows:

1. Spinal injections for non-specific low back pain are not routinely commissioned (this includes all injections such as facet joint injections, therapeutic medial branch blocks and intradiscal therapy together with prolotherapy and trigger point injections e.g. botulinum toxin – this list is not exclusive). 
2. Epidural injections for neurogenic claudication in people with central spinal canal stenosis are not routinely commissioned. 
3. Caudal Epidural / selective nerve root block only under ultrasound or Xray guidance are routinely commissioned for people with acute and severe sciatica. Blind spinal injections are not recommended by NICE. 
4. Radiofrequency denervation of the facet joint for a person with chronic low back pain is routinely commissioned in the following circumstances:
   1. non-surgical treatment has not worked for them
   2. the main source of pain is thought to come from structures supplied by the medial branch nerve, as confirmed by a positive response to a diagnostic medial branch block within the last 6 months
   3. they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent). 
5. Ensure all patients undergoing radiofrequency denervation have received a rehabilitation programme tailored to their needs and continue to commit to long term self-management of their rehabilitation. 

Option A:

6. A repeat denervation procedure is allowed at a frequency of not less than two years. 

OR

Option B: 

6. A repeat denervation procedure is allowed at a frequency of 18 months since the first denervation if clinically indicated. 

Notes for clinicians: 

• Please also refer to NHS England BestMSK guidance toolkit for primary and community care – Spinal pain/sciatica. This guidance can be found on the BestMSK Health Collaborative workspace on the NHS England NHS Futures website FutureNHS Home - FutureNHS Collaboration Platform

Exclusions

• The following indications are considered outside the scope of this policy and are therefore excluded:-
  • conditions with a select and uniform pathology of a mechanical nature (for example, spondylolisthesis, scoliosis, vertebral fracture or congenital diseases) OR
  • conditions of a non-mechanical nature (for example, ankylosing spondylitis or diseases of the viscera)
  • Sacroiliac joint dysfunction.
  • This policy applies to the therapeutic use of spinal injections. When these are being used diagnostically, this is considered to be outside the scope of the policy and are therefore excluded.
  • In line with the Getting It Right First Time (GIRFT) pathway (October 2023), it is recommended that:-
  • emergency (i.e. same day) referral is made for patients with back pain and symptoms of Cauda Equina Syndrome or
  • urgent (i.e. within 2 weeks) referral with sudden onset of back pain without Cauda Equina Syndrome symptoms.
  • Otherwise, cauda equina syndrome is considered to be outside the scope of this policy.

Share your thoughts here: www.smartsurvey.co.uk/s/Spinalinjectionsradiofrequencydenervationforlowbackpainclinicalpolicyquestionnaire/

Survey closes at midnight on Friday 26 December 2025.

This is a non-surgical therapy that helps you relearn to move your face muscles in a natural way after an injury to the facial nerve. It includes exercises to improve face movement, coordination, and expression.

View the current policy here: Commissioning Policy:

In this case the policy title is the main change so that it includes the scope of the policy -in facial palsy. In light of this change the policy now moves from a criteria based approach to a not-routinely commissioned (paid for) approach which means it could result in less provision for some people. The new wording is simply as follows:

Physical therapy (which includes tailored facial exercises) are not routinely commissioned in the management of facial palsy due to Bell’s or other causes.

Share your thoughts here: www.smartsurvey.co.uk/s/PolicyforPhysicalRehabilitationinFacialPalsyClinicalpolicyquestionnaire/

Survey closes at midnight on Saturday 10 January 2026.

Rhinoplasty is a surgical procedure to change the shape of the nose for cosmetic or functional reasons.

The policy is to be amended following advice from specialist clinicians who agreed that rhinoplasty may be needed for some septal deformities. The change includes the addition of criteria from recent guidance and one exclusion.

The proposed wording is as follows:

1. Rhinoplasty and septorhinoplasty are not commissioned for cosmetic purposes.
2. Rhinoplasty and septorhinoplasty are commissioned when there is:
   1. Persistent obstruction of the nasal airway AND
   2. Septal OR external deformity AND
   3. A NOSE score of 30 or higher AND
   4. A trial of conservative therapy has failed or is contraindicated AND
   5. Septoplasty or turbinate surgery alone are unlikely to be effectiv
3. The following are excluded and therefore not restricted by this policy:
   1. Repair of complex congenital deformities, such as cleft lip and palate.
   2. Investigation or treatment of tumours.
   3. Septal perforation repair.

Share your thoughts here: www.smartsurvey.co.uk/s/RhinoplastyClinicalpolicyquestionnaire/

Survey closes at midnight on Saturday 10 January 2026.

This policy covers surgery to improve the appearance of scars, making them less noticeable.

You can view the current policy here: Policy for Cosmetic Procedures - 18. Surgical Revision of Scars: Restricted

Following National Institute for Health and Care Excellence (NICE) guidance the amended policy adds a minimum waiting time, the requirement that conservative therapies are tried before surgery, the requirement for therapy to be delivered via an existing NHS pathway, the requirement for patient counselling, particularly in relation to keloid scars and the addition of exclusions.

The revised policy wording is proposed as follows:

1. Surgical revision of scarring is commissioned when:
   1. The scar is causing functional disability, recurrent bleeding or significant pain resulting in functional limitations.
   2. 2 years have elapsed to allow full healing of the scar.
   3. Less invasive treatments have been tried or are unsuitable.
   4. The patient has been fully counselled in relation to the risks and benefits, particularly where there are keloid scars.
   5. Revision is delivered through an existing NHS plastic surgery or dermatology pathway.

Exclusions:

• Malignancy investigation and treatment pathways.
• Congenital deformity or trauma reconstruction pathways.
• Management of contractures.
• Management of chronic wound infection.

Removal methods included in this policy section include:

• Surgical excision
• Cauterisation
• Cryosurgery
• Cryotherapy
• Electrodessication and curettage
• Chemical peeling
• Laser destruction
• Dermabrasion

The ICB has noted the recommendation in NICE NG198 that clinicians should ‘consider’ offering CO2 laser or glycolic peel for severe acne scarring. It has also noted the NICE committee statement this is a weak recommendation due to lack of evidence. The ICB has decided not to commission surgical treatment of acne scarring on the basis of the NICE finding that the evidence is limited.

Share your thoughts here: www.smartsurvey.co.uk/s/SurgicalrevisionofscarsCosmeticclinicalpolicyquestionnaire/

Survey closes at midnight on Saturday 10 January 2026.