title: Implementation of national body contouring surgery guidelines following massive weight loss: A national cross-sectional survey of commissioning in England.
abstract: BACKGROUND
  National guidelines for commissioning of body contouring surgery (BCS) following massive weight loss (MWL) in England were published in 2014. Nearly three-quarters of patients who have MWL seek BCS; however, access is known to vary according to the region. The aim of national guidelines was to standardise access. The purpose of this study was to determine implementation of the national guidelines by clinical commissioning groups (CCGs) in England.
  
  
  METHODS
  A cross-sectional, web-based survey was sent to all CCG chairs in England.
  
  
  RESULTS
  Of 211 potential respondents, 108 completed the survey or provided funding guidelines (response rate = 52%). Eight CCGs (7%) had implemented the guidelines. A total of 69 CCGs were aware of the new guidelines (64%), and 66 CCGs stated that they fund BCS after MWL (61%). A total of 81 CCGs (75%) identified local funding guidelines, while 15 CCGs (14%) cited individual funding requests (IFRs) as the means of accessing funding. To improve patient access to BCS; 58 of 65 respondents (89%) stated cost-effectiveness, whereas 56 of 75 respondents (75%) thought patient-reported outcome measures were key. Qualitative data to improve access included an integrated pathway from bariatric surgery to BCS, an improved evidence base and greater CCG finances. One CCG stated that it cannot afford to fund cosmetic procedures.
  
  
  CONCLUSIONS
  The purpose of national guidelines was to simplify the pathway to BCS after MWL and create fair distribution of funds across the country to needy patients; however, their uptake has been poor. Access to funding for BCS across England varies according to the location.
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom. Electronic address: Jonathan.a.dunne@gmail.com.
authors: Jonathan A
authors: JA
authors: Dunne
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors: Justin C R
authors: JC
authors: Wormald
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors: Reshma
authors: R
authors: Ghedia
authors: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors: Mark
authors: M
authors: Soldin
mesh_terms: D003430:Cross-Sectional Studies; D004739:England; D019983:Guideline Adherence; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D009765:Obesity / Q000601:surgery*; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures; D015431:Weight Loss
keywords: Body contouring; Commissioning; Massive weight loss