Reviewing local health policies

The local NHS is reviewing local policies for routine procedures that are known to have a medical benefit only in very specific situations, or for a small group of people.

This will involve reviewing over 100 policies and treatments, with the aim to;

  • To ensure that the latest medical guidance and techniques are being used and so the best treatment is being provided to each patient.
  • To ensure that NHS resources are being used in the best possible way for all patients
  • To provide more equal access to healthcare and treatments, where possible.

Seven NHS Clinical Commissioning Groups (CCGs) have joined together (Halton, Knowsley, Liverpool, Southport and Formby, South Sefton, St Helens and Warrington) to do this work.

Six CCGs are working joined together (Halton, Liverpool, Southport and Formby, South Sefton, St Helens and Warrington) to review these policies over the next 12 months, and during this time you will regularly have the opportunity to have your say on a variety of procedures and treatments.

Please see the full list of the first set of policies/procedures being reviewed below.

  1. Abdominoplasty and apronectomy – Tummy tuck
  2. Breast enlargement
  3. Breast reduction
  4. Cataract surgery
  5. Face and Brow lift
  6. Hemorrhoidectomy
  7. Hair removal (for excessive hair growth – Hirsutism)
  8. Laser tattoo removal
  9. Male breast reduction
  10. Male circumcision
  11. Pinnaplasty – ear pinning
  12. Removal of breast implants
  13. Rhinoplasty – Nose job
  14. Surgical body contouring – Removal of excess skin
  15. Surgical correction of scars
  16. Surgical removal of lipoma (fatty tissue)
  17. Surgical removal of minor skin lesions
  18. Surgical treatment for hair loss – hair transplantation

The outcome from the engagement work carried out so far is being processed through governing body and will be approved later this spring.


We are now moving into the next phase of this work. The next set of policies includes:

  • Subfertility
  • Cough Assist Devices
  • Secondary Care Administered Joint Injections
  • Surgery for Prostatism/Lower Urinary Tract System
  • Botulinum Toxin A&B
  • Treatments for Dupytrens Disease
  • Continuous Glucose Monitoring systems for continuous monitoring in Type 1 Diabetes Mellitus and Insulin pump
  • Transanal Irrigation

For more information, or to let us know your thoughts please contact: 0121 6123 806 or email us on:


Frequently asked questions

What is the Review for?

We need to review these policies every few years to make sure they follow the latest medical guidance and are the most effective treatment for patients, as well as ensuring NHS resources are used in the best possible way. Additionally, currently, the criteria in the policies are different depending on where you live, which can be frustrating for you, your GPs and your consultants. This review aims to standardise the policies across the local areas where possible and appropriate.

What does this mean for me?

A change in policy might mean that your healthcare needs will be assessed against the same criteria as everyone else when being considered for treatment. This will help to ensure everyone is treated more equally.

Does this mean that these treatments will not be available at all anymore?

No. The treatments will still be available. It is the criteria to receive the treatments that may have changed or the type of treatment you will receive might be different to before.

If you do not meet the criteria for a treatment but your doctor believes you would benefit from the treatment, a Individual Funding Request can be put forward.

What is an individual funding request?

 An individual funding request can be made by your clinician (doctor or other health professional) if they believe that a particular treatment or service that is not routinely offered by the NHS is the best treatment for you, given your individual clinical circumstances.

Why are some treatments not routinely offered by the NHS?

The vast majority of treatments and services that patients need are offered routinely by the NHS. There may be some cases however where a decision has been taken not to offer the treatment to groups of patients with a particular clinical need. This may be because there is limited evidence for how well the treatment works in those patients or because the treatment is very expensive and doesn’t offer good value for money for the NHS. There will also be some circumstances where a treatment is still very new and a decision hasn’t been taken yet on whether it should be offered routinely on the NHS.

When can an individual funding request be made?

An individual funding request can be made for a treatment that is not routinely offered by the NHS when a clinician believes that their patient is clearly different to other patients with the same condition or where their patient might benefit from the treatment in a different way to other patients. This is known as “clinical exceptionality”. As an example, dental implants are not routinely offered by the NHS, however if a patients could not use their arms due to a disability and needed dental implants to hold a pen so they could write, this might be considered an exceptional case. Clinicians can also make a request for funding where a decision hasn’t yet been taken on whether a treatment should be offered in the NHS and where their patient’s condition is likely to get a lot worse very quickly and without any prospect of recovery, unless they receive the treatment. This is known as “critical clinical urgency”. Where a request is made on grounds of clinical urgency, the clinician will need to show that the evidence for use of the treatment is strong and that the treatment is likely to represent good value for money compared with other treatments provided routinely by the NHS. Your clinician should explain to you why they believe that a treatment that is not routinely offered by the NHS is the best treatment option for you.

Who can make an individual funding request?

Your clinician will make the funding request on your behalf and will inform you of the outcome. The NHS cannot accept individual funding requests directly from patients.

Who considers the Individual Funding Request application?

Applications will first go through a screening process to make sure all relevant information has been submitted. We will contact your clinician if they need further information. In most cases, the application will then be considered by an expert independent panel of clinicians who will not have been involved in your treatment. The panel also contains an independent lay (public) representative. All panel members have received training to enable them to assess individual funding requests fairly and thoroughly. Your personal details will be kept confidential. We will let your clinician know the outcome of the funding request and you will also be sent a copy of the letter. If the application is unsuccessful then the letter will explain the reasons. When you next see your clinician, they will discuss with you what other treatment options might be available.

How long will an application take?

In urgent cases, applications will be considered within two weeks, and often much sooner. In other cases, applications will usually be considered within four weeks. 

Is this review only about saving money?

No. The most important thing is giving you the best care we can. This review of the policies will help to ensure the NHS can offer you the most effective treatments in line with the latest guidance.

We hope that making the policies the same will help us be more cost and resource effective, but our top priority is to provide equal treatment to all of our patients.

Will the proposed updates limit doctors' decision making?

No. All updates to policies are based on the latest clinical guidance and medical advances. This means that the policies will enable to your doctor to provide you with the best treatments for you based on the latest techniques.

All proposed changes are based on input from clinicians and national guidance, including GP representatives from each CCG, Public Health England, Individual Funding Request panels and specialist consultants, where required.


English If you require this information in another language, please email us on or call us on 0121 6123 806 (standard landline and mobile network rates apply) ​
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