The plastic surgery postcode lottery in England.
OBJECTIVE
The National Health Service (NHS) provides treatment free at the point of delivery to patients. Elective medical procedures in England are funded by 149 independent Primary Care Trusts (PCTs), which are each responsible for patients within a defined geographical area. There is wide variation of availability for many treatments, leading to a "postcode lottery" for healthcare provision in England. The aims were to review funding policies for cosmetic procedures, to evaluate the criteria used to decide eligibility against national guidelines, and to evaluate the extent of any postcode lottery for cosmetic surgery on the National Health Service. This study is the first comprehensive review of funding policies for cosmetic surgery in England.


METHODS
All PCTs in England were asked for their funding policies for cosmetic procedures including breast reduction & augmentation, removal of implants, mastopexy, abdominoplasty, facelift, blepharoplasty, rhinoplasty, pinnaplasty, body lifting, surgery for gynaecomastia and tattoo removal.


RESULTS
Details of policies were received from 124/149 PCTs (83%). Guidelines varied widely; some refuse all procedures, whilst others allow a full range. Different and sometimes contradictory rules governing symptoms, body mass indices, breast sizes, weights, heights, and other criteria are used to assess patients for funding. Nationally produced guidelines were only followed by nine PCTs.


CONCLUSIONS
A "postcode lottery" exists in the UK for plastic surgery procedures, despite national guidelines. Some of the more interesting findings are highlighted.
Department of Plastic and Reconstructive Surgery, SpR Plastic Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom. jh@jameshenderson.net
James
J
Henderson
D019882:Blepharoplasty / Q000191:economics / Q000592:standards; D005260:Female; D005568:Forms and Records Control; D015276:Health Care Rationing / Q000191:economics*; D019538:Health Care Surveys; D006801:Humans; D015187:Lipectomy / Q000191:economics / Q000592:standards; D008297:Male; D016462:Mammaplasty / Q000191:economics / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012225:Rhinoplasty / Q000191:economics / Q000592:standards; D015361:Rhytidoplasty / Q000191:economics / Q000592:standards; D013222:State Medicine / Q000191:economics*; D013518:Surgery, Plastic / Q000191:economics* / Q000592:standards* / Q000639:trends; D013997:Time Factors; D006113:United Kingdom