Plastics Referral Pathway (including scar revision)

For skin lesions:

Do not make a direct referral to plastic surgery unless it is for suspected/possible skin cancer - then follow 2ww referral route (SCCs/ melanomas, not BCCs).
All BCCs should be referred urgently to HCT skin health who will triage according to risk. Please use 'HCT Skin Health Services Central Triage Referral form' and provide adequate information for them to be able to assess (check Skin Cancer (including BCCs) - Suspected pathway).
For benign skin lesions, refer to 'Dermatology for Adults >16 years of age' pathway, and if appropriate refer to HCT Skin Health Service for triage using the 'HCT Skin Health Services Central Triage Referral form'
If lesion does not meet prior approval criteria do not refer, or consider whether an IFR application is appropriate.

For hand problems:

Dupuytren's Contracture - check pathway/ referral criteria; if patient meets criteria GP to get funding approval prior to referral to secondary care.
Trigger Finger - check pathway/ referral criteria; if patient requires further management beyond GP scope, GP to refer to MSK Triage only. If patient meets criteria for surgery, MSK Triage to get funding approval prior to referring to secondary care.
Carpal Tunnel Syndrome - check pathway/ referral criteria; if patient requires further management beyond GP scope, GP to refer to MSK Triage only. If patient meets criteria for surgery, MSK Triage to get funding approval prior to referring to secondary care.

For blepharoplasty and/or brow lift:

Blepharoplasty (upper and lower lid) and brow lift will usually only be funded when there is a medical indication and not for cosmetic reasons.
Go to Blepharoplasty and Brow lift page for further details (NB: secondary care only to apply for prior approval)
- When referring to secondary care, GP to please include visual fields data - if available - to help expedite prior approval funding process with secondary care

For other referrals to plastics (e.g. for Cosmetic Breast Surgery) check relevant ICB cosmetic surgery policies

Cosmetic surgery is not routinely funded by the NHS. Herts & West Essex ICB do, however, have policy criteria for some procedures. If these criteria are not met, advise patient that they do not meet criteria and discharge. If exceptional circumstances, submit an individual funding request (IFR). Please see policy/policies for full information.
If patient meets policy criteria for surgery, Herts & West Essex ICB will approve funding requested at primary care level (NB - it is the responsibility of the GP - not the surgeon - to apply for funding). It should be made clear to the patient that the final decision to proceed with surgery will lie with the surgeon at secondary care, once the surgeon has seen the patient AND agreed that the patient meets the policy criteria.

For further information, see Priorities Forum statements