Demand management in plastic surgery for low priority procedures: The Welsh experience

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2010-11, Vol.63 (11), p.1778-1786
• Main Authors: Hunter, J.E, Laing, J.H.E, Carroll, G
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cosmetic surgery; Demand management; Female; Health Services Needs and Demand - statistics & numerical data; Humans; Lower clinical priority; Male; Medical sciences; Plastic Surgery; Postcode lottery; Rationing; Reconstructive Surgical Procedures - utilization; Referral and Consultation - statistics & numerical data; Resource allocation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery, Plastic - utilization; Wales
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2009.11.008

Summary Introduction Health Commission Wales (Specialist Services) [HCW] are responsible for resource allocation and demand management in plastic surgery for the population of Wales (2.9 M). Since 2004, all low priority plastic surgery referrals have been screened by a single HCW Case Officer against clinical inclusion criteria before the referral is passed to the provider. Only patients fulfilling these criteria proceed to an outpatient appointment, although there is an appeals procedure. Revised guidelines were introduced in 2006. Our aim was to investigate the effectiveness of the process and the impact of the revised criteria. Methods The Case Officer's database was used to determine numbers of index procedures referred and those disallowed before and after the policy change. Results Since 2004 9,654 referrals have been screened. In 2005–6, 32.5% failed to meet the inclusion criteria and were disallowed. In the year after the policy revision fewer low priority patients were referred (1720 vs. 2013) and more (46.6%) were declined. Body contouring / abdominoplasty were particularly affected with 73.2% not compliant with funding criteria. Conclusion The Welsh model is an efficient, effective and equitable system for demand management, which amounts to thousands of requests per year. After 2006, tighter guidelines have resulted in a higher proportion of patients not meeting the criteria for funding, particularly for body contouring / abdominoplasty procedures. Difficulties remain however in determining reproducible and clinically appropriate criteria for patients seeking plastic surgery following massive weight-loss. Whilst this process streamlines the provision of NHS plastic surgery for the people of Wales, there is a potential impact on specialist training.