Access to aesthetic surgery is very restricted in the NHS and all referrals must be made via the Exceptional Aesthetic Referral Pathway (EARP) see in Resources and Links. It is accepted that in some cases the patient and their GP will not recognise these conditions as being purely cosmetic as there may be significant associated physical symptoms and psychological upset. Nonetheless the guidelines state that all such patients must be referred via the EARP that includes a panel of surgeons and psychologists. Examples of aesthetic surgery include breast augmentation and reduction, abdominoplasty and body contouring surgery following massive weight loss. The EARP guidelines (see Additional Resource) formalise a list of conditions for which the NHS will not usually offer surgery. However, exclusion criteria have been defined, which if met, may indicate that surgery is appropriate.
You are at liberty to refer patients in cases where you consider there to be exceptional circumstances, such as severe and prolonged psychological distress. However these patients will in the first instance be seen by a designated clinical psychologist and will only be referred on for plastic surgery assessment if they have sufficient mental health grounds for surgery and have no psychological contraindications.
Who to refer:
- Patients who satisfy the EARP criteria and are requesting aesthetic surgery on the NHS.
Who not to refer:
- Patients who fail to meet the EARP criteria.
- Patients previously treated for the same condition in the private sector should contact their initial provider in the first instance.
How to refer:
Via SCI gateway to the EARP service at St John’s Hospital with appropriate detail and background information provided.
