title: Primary care trust commissioning of varicose vein intervention--new guidance needed?
abstract: OBJECTIVE
  In light of evidence of national variability in service commissioning of varicose vein intervention, our aim was to evaluate the current state of primary care trust commissioning for all forms of varicose vein intervention in England. We also sought to clarify the extent to which access to endovenous and surgical varicose vein services is being restricted.
  
  
  METHODS
  Under the Freedom of Information Act (2001), a structured email survey was sent to 108 primary care trusts in England. Trusts were asked how many elective endovenous laser therapy and open procedures were commissioned from 2008 to 2011 and they were asked to submit their commissioning policy for analysis. The 'qualifying criteria' expressed in each policy were analysed by theme and geographical region.
  
  
  RESULTS
  Of 108 surveys, 95 (88%) were completed and returned. Of these, 91 (96%) stated that varicose vein interventions were actively commissioned. Eighty-eight (97%) of primary care trusts that commissioned varicose vein interventions stated that access was restricted. Qualifying criteria varied considerably between regions.
  
  
  CONCLUSIONS
  Access to varicose vein intervention appears to be restricted, with national variation in commissioning across England. This might have an impact on patient care and surgical training. We propose that a national decision be made about which varicose vein patients should be offered funding for treatment on the National Health Service.
authors.affiliation: Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK Division of Cardiovascular and Diabetes Research, LIGHT laboratories, Leeds, UK kgriffin@doctors.org.uk.
authors.forename: Kathryn Jane
authors.initials: KJ
authors.lastname: Griffin
authors.affiliation: University of Leeds Medical School, Worsley Building, University of Leeds, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousins
authors.affiliation: Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK Division of Cardiovascular and Diabetes Research, LIGHT laboratories, Leeds, UK.
authors.forename: Marc Aaron
authors.initials: MA
authors.lastname: Bailey
authors.affiliation: Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: David
authors.initials: D
authors.lastname: Berridge
authors.affiliation: Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK Division of Cardiovascular and Diabetes Research, LIGHT laboratories, Leeds, UK.
authors.forename: David Julian Ashbridge
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D057510:Endovascular Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000592:standards*; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014648:Varicose Veins / Q000453:epidemiology / Q000601:surgery*
keywords: Varicose veins; commissioning; endovenous laser therapy; primary care trust