Plastic surgery via the NHS
In England, the provision of plastic surgery in the NHS is commissioned in the same way as all other clinical activity – by NHS providers, such as hospitals and trusts.
Arrangements in the devolved health services of Wales, Scotland and Northern Ireland are slightly different with less emphasis on the ‘internal market’ and competition and more on collaborative planning.
People do not always understand that, like other forms of clinical activity, plastic surgery provision in the NHS only exists in an area because it has been planned by local clinical commissioning groups or other commissioners according to local priorities.
Working with BAPRAS, in 2006, the NHS Modernisation Agency issued this documentation about the provision of plastic surgery services across the UK. However, based on a whole host of factors about the population and area they serve, local commissioners of healthcare still have to decide where their financial resources are best allocated. This means that, even for something as important as reconstructive plastic surgery, access for patients under the NHS may vary around the country – both in terms of location and the range of services available.
In practice, NHS plastic surgeons receive referrals from consultant colleagues and GPs in areas where plastic surgery services have been commissioned. In the local rules set by commissioners, some plastic surgery procedures are considered to be lower priority or not sufficiently effective to warrant investment.
Plastic surgery via private healthcare
In private healthcare, the relationship between patient and plastic surgeon is different. Although some NHS Trusts have private wings, the consultant usually works in a private hospital or clinic. BAPRAS encourages patients to seek a referral from their GP for private plastic surgery but this is not always mandatory. There are no restrictions on who can have a consultation – except, in the case where patients have private medical insurance, this will not cover purely cosmetic procedures and might not cover certain reconstructive plastic surgery techniques. Of course, in cosmetic surgery, when the patient is paying themselves there are no restrictions whatsoever on who can have a consultation.