Financial cuts limit numbers going under the knife in plastic surgery

We were interested to read the editorial by McCartney and Finnikin about choosing NHS interventions wisely.¹ As plastic surgery trainees, we often encounter dissatisfied patients turned away from clinic for procedures that are no longer NHS funded, and see consultant colleagues disappointed at being unable to practise many aspects of their speciality. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has issued commissioning guidelines for patients undergoing body-contouring procedures following massive weight loss. These procedures lead to sustained weight loss, as well as reducing the rate of other complications such as intertrigo,² but are still deemed cosmetic by CCGs, and will be funded only if an Individual Funding Request (IFR) application proves exceptional clinical need.³ We think that we should be supporting patients wishing to undergo these operations. Beside psychological and medical benefits to patients, unnecessary appointments in general practice are thought to cost the NHS over £300 million a year.⁴

We wish to highlight the BAPRAS Massive Weight Loss Body Contouring UK commissioning guidelines.⁵ Encouraging patients to meet the criteria prior to referral can reduce unnecessary clinic appointments, re-referral, and patient dissatisfaction. Successful adherence to these guidelines will give the IFR the greatest chance of being accepted and allowing surgery to proceed.

• © British Journal of General Practice 2019